Provider Demographics
NPI:1215176987
Name:BAY RIDGE GASTROENTEROLOGY, PLLC
Entity type:Organization
Organization Name:BAY RIDGE GASTROENTEROLOGY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP
Authorized Official - Prefix:
Authorized Official - First Name:ANILA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOXHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-745-0623
Mailing Address - Street 1:7601 4TH AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3207
Mailing Address - Country:US
Mailing Address - Phone:718-745-0623
Mailing Address - Fax:718-745-8091
Practice Address - Street 1:7601 4TH AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3207
Practice Address - Country:US
Practice Address - Phone:718-745-0623
Practice Address - Fax:718-745-8091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty