Provider Demographics
NPI:1326136177
Name:TEANECK GASTROENTEROLOGY&ENDOSCOPY CENTER
Entity Type:Organization
Organization Name:TEANECK GASTROENTEROLOGY&ENDOSCOPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-837-7728
Mailing Address - Street 1:1086 TEANECK RD
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4854
Mailing Address - Country:US
Mailing Address - Phone:201-837-7728
Mailing Address - Fax:201-578-1089
Practice Address - Street 1:1086 TEANECK RD
Practice Address - Street 2:SUITE 3B
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4854
Practice Address - Country:US
Practice Address - Phone:201-837-7728
Practice Address - Fax:201-578-1089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ311067Medicare ID - Type Unspecified