Provider Demographics
NPI:1497874358
Name:THE CENTER FOR GASTROENTEROLOGY AND LIVER DISORDERS LLC
Entity Type:Organization
Organization Name:THE CENTER FOR GASTROENTEROLOGY AND LIVER DISORDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-866-2400
Mailing Address - Street 1:255 STATE RT 3
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-3857
Mailing Address - Country:US
Mailing Address - Phone:201-866-2400
Mailing Address - Fax:201-866-0444
Practice Address - Street 1:255 STATE RT 3
Practice Address - Street 2:SUITE 210
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-3857
Practice Address - Country:US
Practice Address - Phone:201-866-2400
Practice Address - Fax:201-866-0444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA50168207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ084800Medicare ID - Type Unspecified