Provider Demographics
NPI:1073944005
Name:THE GASTROENTEROLOGY GROUP OF NORTHERN NEW JERSEY,LLC
Entity Type:Organization
Organization Name:THE GASTROENTEROLOGY GROUP OF NORTHERN NEW JERSEY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/BOARD OF GOVERNORS
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:FRIEDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-569-7044
Mailing Address - Street 1:420 GRAND AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631
Mailing Address - Country:US
Mailing Address - Phone:201-569-7044
Mailing Address - Fax:201-569-1999
Practice Address - Street 1:420 GRAND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4152
Practice Address - Country:US
Practice Address - Phone:201-569-7044
Practice Address - Fax:201-569-1999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03997000207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty