Provider Demographics
NPI:1497932271
Name:GASTROENTEROLOGY ASSOCIATES OF NEW JERSEY, LLC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES OF NEW JERSEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-785-2277
Mailing Address - Street 1:1130 MCBRIDE AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-3806
Mailing Address - Country:US
Mailing Address - Phone:973-812-1400
Mailing Address - Fax:973-812-1404
Practice Address - Street 1:1130 MCBRIDE AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424-3806
Practice Address - Country:US
Practice Address - Phone:973-812-1400
Practice Address - Fax:973-812-1404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0175714Medicaid
NJ1945759OtherAETNA HMO GROUP NUMBER
NJ3533132000OtherAMERIHEALTH GROUP NUMBER
NJ9341206OtherAETNA PPO GROUP NUMBER
NJ133334Medicare PIN