Provider Demographics
NPI:1114933926
Name:ESSEX GASTRO ASSOCIATES, PA
Entity Type:Organization
Organization Name:ESSEX GASTRO ASSOCIATES, PA
Other - Org Name:FIRPO GUERRERO, MD, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FIRPO
Authorized Official - Middle Name:EUGENIO
Authorized Official - Last Name:GUERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-589-5545
Mailing Address - Street 1:275 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-1570
Mailing Address - Country:US
Mailing Address - Phone:973-589-5545
Mailing Address - Fax:973-589-0073
Practice Address - Street 1:275 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-1570
Practice Address - Country:US
Practice Address - Phone:973-589-5545
Practice Address - Fax:973-589-0073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ24MA04217500207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0036633Medicaid
NJ0036633Medicaid