1003853128 NPI number — DIGESTIVE DISEASE CENTER OF NJ LLC

Table of content: (NPI 1003853128)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003853128 NPI number — DIGESTIVE DISEASE CENTER OF NJ LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIGESTIVE DISEASE CENTER OF NJ LLC
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:
1003853128
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33 CLYDE RD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
SOMERSET
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08873-5032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-873-9200
Provider Business Mailing Address Fax Number:
732-873-1699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 CLYDE RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08873-5032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-873-9200
Provider Business Practice Location Address Fax Number:
732-873-1699
Provider Enumeration Date:
05/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RAPISARDA
Authorized Official First Name:
ALEXANDER
Authorized Official Middle Name:
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
732-873-9200

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  25MA06451300 , 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: 5198476 . This is a "AETNA PPO GROUP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: CA0907 . This is a "RRMDCR GROUP # SOMERSET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 510770 . This is a "AETNA HMO GROUP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: CA1979 . This is a "RRMDCR GROUP # EB" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0827446000 . This is a "AMERIHEALTH GROUP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2400803 . This is a "GHI PPO GROUP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2932806 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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