Provider Demographics
NPI:1962782300
Name:FARMINGDALE ENDOSCOPY
Entity type:Organization
Organization Name:FARMINGDALE ENDOSCOPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:FAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-650-1800
Mailing Address - Street 1:1943 VINCENT LN
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-9629
Mailing Address - Country:US
Mailing Address - Phone:516-650-1800
Mailing Address - Fax:516-364-9796
Practice Address - Street 1:1111 RTE 110
Practice Address - Street 2:SUITE 205
Practice Address - City:EAST FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735
Practice Address - Country:US
Practice Address - Phone:631-752-7000
Practice Address - Fax:516-364-9796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYS 178331261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty