Provider Demographics
NPI:1003853128
Name:DIGESTIVE DISEASE CENTER OF NJ LLC
Entity Type:Organization
Organization Name:DIGESTIVE DISEASE CENTER OF NJ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:RAPISARDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-873-9200
Mailing Address - Street 1:33 CLYDE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-5032
Mailing Address - Country:US
Mailing Address - Phone:732-873-9200
Mailing Address - Fax:732-873-1699
Practice Address - Street 1:33 CLYDE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5032
Practice Address - Country:US
Practice Address - Phone:732-873-9200
Practice Address - Fax:732-873-1699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06451300207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5198476OtherAETNA PPO GROUP #
NJCA0907OtherRRMDCR GROUP # SOMERSET
NJ510770OtherAETNA HMO GROUP #
NJCA1979OtherRRMDCR GROUP # EB
NJ0827446000OtherAMERIHEALTH GROUP #
NJ2400803OtherGHI PPO GROUP #
NJ2932806Medicaid
NJCA0907OtherRRMDCR GROUP # SOMERSET