Provider Demographics
NPI:1699974881
Name:GASTROENTROLOGY SERVICES OLM
Entity type:Organization
Organization Name:GASTROENTROLOGY SERVICES OLM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HILLARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERTAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-920-9070
Mailing Address - Street 1:158 W 27TH ST
Mailing Address - Street 2:11TH FLOOR SOUTH
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6216
Mailing Address - Country:US
Mailing Address - Phone:212-563-2627
Mailing Address - Fax:
Practice Address - Street 1:600 E 233RD ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2604
Practice Address - Country:US
Practice Address - Phone:718-920-9070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156652207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty