Provider Demographics
NPI:1144240482
Name:ATLANTIC GASTROENTEROLOGY ASSOCIATES, P.A.
Entity type:Organization
Organization Name:ATLANTIC GASTROENTEROLOGY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-407-1220
Mailing Address - Street 1:3205 FIRE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5857
Mailing Address - Country:US
Mailing Address - Phone:609-407-1220
Mailing Address - Fax:609-407-0220
Practice Address - Street 1:3205 FIRE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-5857
Practice Address - Country:US
Practice Address - Phone:609-407-1220
Practice Address - Fax:609-407-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
222485119OtherJOHN CHIESA INDIVIDUAL TI
NJ25MB03629600OtherJOHN J SANTORO STATE LICE
NJ25MA01893500OtherLEE P ROSKY STATE LICENSE
NJ2959305Medicaid
NJ25MA04967400OtherGARY A ROSMAN STATE LICEN
NJ25MB02888400OtherJOHN CHIESA STATELICENSE
NJ25MA05301400OtherHOWARD N GARSON STATE LIC
NJ25MA03429200OtherBARRY P KAUFMAN STATE LIC
NJ25MA03908500OtherJOSEPH L SPAAR STATE LICE
NJ25MA03637500OtherNIKHILESH D MEHTA STATE L
185368217OtherJOSEPH L SPAAR IND TIN
NJ25MA03429200OtherBARRY P KAUFMAN STATE LIC
NJ25MB03629600OtherJOHN J SANTORO STATE LICE
054568544OtherHOWARD N GARSON IND TIN
NJ25MA01893500OtherLEE P ROSKY STATE LICENSE
NJ25MA03637500OtherNIKHILESH D MEHTA STATE L
NJ25MA04967400OtherGARY A ROSMAN STATE LICEN
NJ25MA04967400OtherGARY A ROSMAN STATE LICEN
NJ25MA05301400OtherHOWARD N GARSON STATE LIC