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

Table of content: (NPI 1144240482)

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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