Provider Demographics
NPI:1730505298
Name:BARIATRIC ENDOSCOPY INSTITUTE LLC
Entity type:Organization
Organization Name:BARIATRIC ENDOSCOPY INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NITIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-332-4224
Mailing Address - Street 1:400 BROOKLINE AVE
Mailing Address - Street 2:12C
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5408
Mailing Address - Country:US
Mailing Address - Phone:314-332-4224
Mailing Address - Fax:
Practice Address - Street 1:400 BROOKLINE AVE
Practice Address - Street 2:12C
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5408
Practice Address - Country:US
Practice Address - Phone:314-332-4224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036134693207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty