Provider Demographics
NPI:1093750622
Name:CAPE ATLANTIC GASTROENTEROLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:CAPE ATLANTIC GASTROENTEROLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LANDSET
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-465-1511
Mailing Address - Street 1:307 STONE HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-2170
Mailing Address - Country:US
Mailing Address - Phone:609-465-1511
Mailing Address - Fax:609-465-5310
Practice Address - Street 1:307 STONE HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2170
Practice Address - Country:US
Practice Address - Phone:609-465-1511
Practice Address - Fax:609-465-5310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB43341207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4529006Medicaid
NJ679029Medicare ID - Type Unspecified