Organization
GASTRO 2020 PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDNA KHODADADIAN MD (OWNER)
(516) 659-5229
Entity
Organization
Contact information
Practice address
9618 METROPOLITAN AVE, FOREST HILLS, NY 11375-6625
(516) 487-0360
Mailing address
28 LIGHTHOUSE RD, GREAT NECK, NY 11024-1140
(516) 659-5229
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Enumeration date
10/07/2020
Last updated
10/07/2020
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