| Organization Name: | DIGESTIVE DISEASE CENTER OF CENTRAL NEW YORK, LLC |
| NPI Number: | 1053505511 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LAUREEN KEEGAN (ADMINISTRATOR) |
| Mailing Address: | 5112 W Taft Rd Suite E Liverpool |
| State: | NY US |
| Postal Code: | 130884868 |
| Phone Number: | 3154107400 |
| Fax Number: | 3154584183 |
| NPI Enumeration Date: | 08/28/2007 |
| NPI Last Update Date: | 08/25/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |