Provider Demographics
NPI:1235191420
Name:S.J. GASTRINTESTINAL & LIVER SPECIALISTS, PA
Entity Type:Organization
Organization Name:S.J. GASTRINTESTINAL & LIVER SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MUCHAEL
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-772-1600
Mailing Address - Street 1:2301 E EVESHAM RD
Mailing Address - Street 2:BUILDIMG 800 SUITE 110
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4501
Mailing Address - Country:US
Mailing Address - Phone:856-772-1600
Mailing Address - Fax:856-772-9031
Practice Address - Street 1:2301 E EVESHAM RD
Practice Address - Street 2:BUILDIMG 800 SUITE 110
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4501
Practice Address - Country:US
Practice Address - Phone:856-772-1600
Practice Address - Fax:856-772-9031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0427545000OtherAMERIHEALTH
NJ3437108Medicaid
NJ605036Medicare ID - Type Unspecified