MEDICARE: DIGESTIVE DISEASE ASSOCIATES, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	210256	NY
2	207RG0100X	Gastroenterology Physician	222044	NY

General Provider Information

NPI Number	:	1316031503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIGESTIVE DISEASE ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	301 BUEL AVE
Second Line	:	SIDE ENTRANCE
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-2201
Country	:	US
Telephone Number	:	718-980-9898
Fax Number	:	718-980-9897

Provider Business Practice Location Address
First Line	:	1487 RICHMOND RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-2311
Country	:	US
Telephone Number	:	718-980-9898
Fax Number	:	718-980-9897

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PRETAM G. RAMPERSAUD
Credential	:	M.D.
Telephone Number	:	718-980-9898

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	08/22/2020

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