Provider Demographics
NPI:1487835187
Name:MONMOUTH CENTER FOR DIGESTIVE AND HEPATIC HEALTH LLC
Entity Type:Organization
Organization Name:MONMOUTH CENTER FOR DIGESTIVE AND HEPATIC HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIR ABBAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MOOSVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-264-7411
Mailing Address - Street 1:717 N BEERS ST
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1524
Mailing Address - Country:US
Mailing Address - Phone:732-264-7411
Mailing Address - Fax:732-264-1074
Practice Address - Street 1:717 N BEERS ST
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1524
Practice Address - Country:US
Practice Address - Phone:732-264-7411
Practice Address - Fax:732-264-1074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03401800207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ087612Medicare PIN