Provider Demographics
NPI:1871060707
Name:GASTROINTESTINAL WELLNESS CLINIC LLC
Entity type:Organization
Organization Name:GASTROINTESTINAL WELLNESS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTARTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:ELINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-359-0956
Mailing Address - Street 1:301 OXFORD VALLEY RD # UNITS804
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-7706
Mailing Address - Country:US
Mailing Address - Phone:917-359-0956
Mailing Address - Fax:
Practice Address - Street 1:301 OXFORD VALLEY RD # UNITS804
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-7706
Practice Address - Country:US
Practice Address - Phone:917-359-0956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty