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NPI Code Detail

MEDICARE: NORTHEAST GASTROENTEROLOGY CENTER, INC.

MEDICARE: NORTHEAST GASTROENTEROLOGY CENTER, INC.
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
2367500000XCertified Registered Nurse Anesthetist

General Provider Information

NPI Number : 1972854446
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHEAST GASTROENTEROLOGY CENTER, INC.
Provider Business Mailing Address
First Line : 10 PARK PL
Second Line :
City : HAZLE TOWNSHIP
State : PA
Zip : 18202-2885
Country : US
Telephone Number : 570-454-1400
Fax Number : 570-454-2144
Provider Business Practice Location Address
First Line : 10 PARK PL
Second Line :
City : HAZLE TOWNSHIP
State : PA
Zip : 18202-2885
Country : US
Telephone Number : 570-454-1400
Fax Number : 570-454-2144
Authorized Official
Title or Position : PRESIDENT
Name : YOUNG KUL YOO
Credential : MD
Telephone Number : 570-454-1400
Provider Enumeration Date : 09/25/2012
Last Update Date : 09/25/2012

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