| Organization Name: | DOUGLASTON ENDOSCOPY OBS PC |
| NPI Number: | 1366624140 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NEIL MARTIN BRODSKY (MEDICAL DIRECTOR) |
| Mailing Address: | 24102 Northern Blvd Douglaston |
| State: | NY US |
| Postal Code: | 113621061 |
| Phone Number: | 7184610163 |
| Fax Number: | 7183585570 |
| NPI Enumeration Date: | 12/03/2007 |
| NPI Last Update Date: | 02/25/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QE0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Endoscopy |
| Taxonomy Definition: | |