Provider Demographics
NPI:1154035442
Name:LONG ISLAND GASTRO AND HEPATOLOGY, CORP.
Entity type:Organization
Organization Name:LONG ISLAND GASTRO AND HEPATOLOGY, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NABRAS
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-346-3633
Mailing Address - Street 1:649 HORSEBLOCK RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-1235
Mailing Address - Country:US
Mailing Address - Phone:631-346-3633
Mailing Address - Fax:631-320-3054
Practice Address - Street 1:649 HORSEBLOCK RD
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-1235
Practice Address - Country:US
Practice Address - Phone:631-346-3633
Practice Address - Fax:631-320-3054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty