# MODERN GASTROENTEROLOGY PC

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

## Provider details

- **NPI number:** 1578965638
- **Authorized official:** KONSTANTIN VAIZMAN MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (347) 446-6839

## Contact information

- **Practice address:** 2705 MERMAID AVE, BROOKLYN, NY 11224-2005
- **Practice address phone:** (718) 265-2222
- **Practice address fax:** (718) 333-1023
- **Mailing address:** 947 79TH ST, STE 1, BROOKLYN, NY 11228-2613
- **Mailing address phone:** (347) 446-6839
- **Mailing address fax:** (718) 333-1023

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RG0100X | Gastroenterology Physician | — | NULL | Yes |
| 207RG0100X | Gastroenterology Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/20/2014
- **Last updated:** 09/20/2014