MEDICARE: GASTROPATH

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

General Provider Information

NPI Number	:	1437418076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GASTROPATH

Provider Business Mailing Address
First Line	:	22 E 88TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-0509
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5600 KENNEDY BLVD W
Second Line	:
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-1256
Country	:	US
Telephone Number	:	201-902-9500
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	HARRY SNADY
Credential	:	MD PHD
Telephone Number	:	201-902-9500

Provider Enumeration Date	:	05/15/2012
Last Update Date	:	05/15/2012

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