Provider Demographics
NPI:1306862883
Name:NORTH JERSEY GASTROENTEROLOGY ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:NORTH JERSEY GASTROENTEROLOGY ASSOCIATES, P.A.
Other - Org Name:NORTH JERSEY GASTROENTEROLOGY ASSOCIATES, P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:FISKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-325-5775
Mailing Address - Street 1:1500 PLEASANT VALLEY WAY
Mailing Address - Street 2:SUITE 306
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2956
Mailing Address - Country:US
Mailing Address - Phone:973-325-5775
Mailing Address - Fax:973-325-5770
Practice Address - Street 1:1500 PLEASANT VALLEY WAY
Practice Address - Street 2:SUITE 306
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2956
Practice Address - Country:US
Practice Address - Phone:973-325-5775
Practice Address - Fax:973-325-5770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA34473174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2939100Medicaid
NJ654866OtherUNITED HEALTHCARE
NJ0041150OtherAETNA HMO
NJ4093402OtherAETNA
NJ1019473-001OtherCIGNA HMO
NJHUL00021200OtherAMERICHOICE OF NJ
NJ0068449700OtherAMERIHEALTH
NJ80847OtherAMERICHOICE
NJ1072840OtherHORIZON NJ HEALTH
NJBS008OtherOXFORD
NJOK5988OtherHEALTHNET
NJ21626OtherUHP
NJ31D0105815OtherCLIA #
NJ4093402OtherAETNA
NJ2939100Medicaid
NJ0068449700OtherAMERIHEALTH