Provider Demographics
NPI:1174821516
Name:COLON AND RECTAL SPECIALISTS,PA
Entity Type:Organization
Organization Name:COLON AND RECTAL SPECIALISTS,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-913-7677
Mailing Address - Street 1:255 W SPRING VALLEY AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-1445
Mailing Address - Country:US
Mailing Address - Phone:201-525-1031
Mailing Address - Fax:201-880-4560
Practice Address - Street 1:255 W SPRING VALLEY AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1445
Practice Address - Country:US
Practice Address - Phone:201-525-1031
Practice Address - Fax:201-880-4560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
064693OtherMEDICARE ID
NJH50460Medicare UPIN