Provider Demographics
NPI:1134288152
Name:NORTH JERSEY COLON & RECTAL SURGICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:NORTH JERSEY COLON & RECTAL SURGICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:NIZIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-791-4002
Mailing Address - Street 1:4-14 SADDLE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-5632
Mailing Address - Country:US
Mailing Address - Phone:201-791-4002
Mailing Address - Fax:201-791-7040
Practice Address - Street 1:4-14 SADDLE RIVER RD
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-5632
Practice Address - Country:US
Practice Address - Phone:201-791-4002
Practice Address - Fax:201-791-7040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA44217208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0439207Medicaid
NJ7970404Medicaid
NJ0505803Medicaid
NJ1008706Medicaid
NJ526636Medicare PIN