1306862883 NPI number — NORTH JERSEY GASTROENTEROLOGY ASSOCIATES, P.A.

Table of content: (NPI 1306862883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306862883 NPI number — NORTH JERSEY GASTROENTEROLOGY ASSOCIATES, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH JERSEY 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:
NORTH JERSEY GASTROENTEROLOGY ASSOCIATES, P.A.
Provider Other Organization Name Type Code:
4
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:
1306862883
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 PLEASANT VALLEY WAY
Provider Second Line Business Mailing Address:
SUITE 306
Provider Business Mailing Address City Name:
WEST ORANGE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07052-2956
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-325-5775
Provider Business Mailing Address Fax Number:
973-325-5770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 PLEASANT VALLEY WAY
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
WEST ORANGE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07052-2956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-325-5775
Provider Business Practice Location Address Fax Number:
973-325-5770
Provider Enumeration Date:
07/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FISKE
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
CRAIG
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
973-325-5775

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MA34473 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2939100 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 654866 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0041150 . This is a "AETNA HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4093402 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1019473-001 . This is a "CIGNA HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: HUL00021200 . This is a "AMERICHOICE OF NJ" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0068449700 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 80847 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1072840 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: BS008 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: OK5988 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 21626 . This is a "UHP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 31D0105815 . This is a "CLIA #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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