Provider Demographics
NPI:1447558655
Name:NEW JERSEY ADVANCED GASTROENTEROLOGY, LLC
Entity Type:Organization
Organization Name:NEW JERSEY ADVANCED GASTROENTEROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SOHAIL
Authorized Official - Middle Name:N
Authorized Official - Last Name:SHAIKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-638-1740
Mailing Address - Street 1:1225 MCBRIDE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2540
Mailing Address - Country:US
Mailing Address - Phone:973-638-1740
Mailing Address - Fax:
Practice Address - Street 1:1225 MCBRIDE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424-2540
Practice Address - Country:US
Practice Address - Phone:973-638-1740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-11
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07916100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty