1144240482 NPI number — ATLANTIC GASTROENTEROLOGY ASSOCIATES, P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144240482 NPI number — ATLANTIC GASTROENTEROLOGY ASSOCIATES, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLANTIC GASTROENTEROLOGY ASSOCIATES, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144240482
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3205 FIRE RD
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
EGG HARBOR TOWNSHIP
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08234-5857
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-407-1220
Provider Business Mailing Address Fax Number:
609-407-0220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3205 FIRE RD
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
EGG HARBOR TOWNSHIP
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08234-5857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-407-1220
Provider Business Practice Location Address Fax Number:
609-407-0220
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KAUFMAN
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
609-407-1220

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 222485119 . This is a "JOHN CHIESA INDIVIDUAL TI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 25MB03629600 . This is a "JOHN J SANTORO STATE LICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 25MA01893500 . This is a "LEE P ROSKY STATE LICENSE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2959305 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 25MA04967400 . This is a "GARY A ROSMAN STATE LICEN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 25MB02888400 . This is a "JOHN CHIESA STATELICENSE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 25MA05301400 . This is a "HOWARD N GARSON STATE LIC" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 25MA03429200 . This is a "BARRY P KAUFMAN STATE LIC" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 25MA03908500 . This is a "JOSEPH L SPAAR STATE LICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 25MA03637500 . This is a "NIKHILESH D MEHTA STATE L" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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