Provider Demographics
NPI:1336258128
Name:NEW YORK GI CENTER LLC
Entity type:Organization
Organization Name:NEW YORK GI CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:COSTABILE
Authorized Official - Last Name:DILORENZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-725-9115
Mailing Address - Street 1:1200 WATERS PL
Mailing Address - Street 2:SUITE M117
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2728
Mailing Address - Country:US
Mailing Address - Phone:718-863-0575
Mailing Address - Fax:718-863-2467
Practice Address - Street 1:1200 WATERS PL
Practice Address - Street 2:SUITE M117
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2728
Practice Address - Country:US
Practice Address - Phone:718-863-0575
Practice Address - Fax:718-863-2467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02898864Medicaid
NYNE0Z88290Medicare PIN