# GREAT SOUTH BAY ENDOSCOPY CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366864514
- **Authorized official:** ALICIA MOHAN (ADMINISTRATOR)
- **Authorized official phone:** (631) 307-9181

## Contact information

- **Practice address:** 260 PATCHOGUE YAPHANK RD, SUITE C, EAST PATCHOGUE, NY 11772-4886
- **Practice address phone:** (631) 307-9181
- **Practice address fax:** (631) 312-9187
- **Mailing address:** 260 PATCHOGUE YAPHANK RD STE C, EAST PATCHOGUE, NY 11772-4886
- **Mailing address phone:** (631) 307-9181
- **Mailing address fax:** (631) 312-9187

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/07/2014
- **Last updated:** 11/04/2025