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NPI Code Detail

MEDICARE: REGO PARK ENDO, LLC

MEDICARE: REGO PARK ENDO, LLC
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
1207L00000XAnesthesiology Physician
2261QA1903XAmbulatory Surgical Clinic/Center

General Provider Information

NPI Number : 1407642366
Entity Type Code : Organization
Provider Name (Legal Business Name) : REGO PARK ENDO, LLC
Provider Business Mailing Address
First Line : 9901 QUEENS BLVD FL 2
Second Line :
City : REGO PARK
State : NY
Zip : 11374-4512
Country : US
Telephone Number : 718-310-3904
Fax Number :
Provider Business Practice Location Address
First Line : 9901 QUEENS BLVD FL 2
Second Line :
City : REGO PARK
State : NY
Zip : 11374-4512
Country : US
Telephone Number : 267-455-4855
Fax Number :
Authorized Official
Title or Position : MEMBER
Name : ALEXANDER INGRAM
Credential :
Telephone Number : 718-310-3904
Provider Enumeration Date : 04/17/2025
Last Update Date : 04/21/2026

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