| Gastro 2020 Pllc | |
|
9618 Metropolitan Ave Forest Hills NY 11375-6625 | |
| (516) 487-0360 | |
| Not Available |
| Full Name | Gastro 2020 Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 9618 Metropolitan Ave, Forest Hills, New York |
| Authorized Official Name and Position | Edna Khodadadian (OWNER) |
| Authorized Official Contact | 5166595229 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gastro 2020 Pllc 28 Lighthouse Rd Great Neck NY 11024-1140 Ph: (516) 659-5229 | Gastro 2020 Pllc 9618 Metropolitan Ave Forest Hills NY 11375-6625 Ph: (516) 487-0360 |
| NPI Number | 1326645870 |
|---|---|
| Provider Enumeration Date | 10/07/2020 |
| Last Update Date | 10/07/2020 |
| Medicare PECOS PAC ID | 6608287545 |
|---|---|
| Medicare Enrollment ID | O20201124002286 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326645870 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
| Provider Name | Edna Khodadadian |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1124198569 PECOS PAC ID: 0749243657 Enrollment ID: I20041110001058 |
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