Provider Demographics
NPI:1518078757
Name:COMMUNITY GASTROENTEROLOGY CENTER PA
Entity Type:Organization
Organization Name:COMMUNITY GASTROENTEROLOGY CENTER PA
Other - Org Name:INCORPORATED PRACTICE
Other - Org Type:Other Name
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:TUSHARSINDHU
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHAUHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-795-5950
Mailing Address - Street 1:1000 S BURNT MILL RD
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2215
Mailing Address - Country:US
Mailing Address - Phone:856-795-5950
Mailing Address - Fax:856-795-5951
Practice Address - Street 1:1000 S BURNT MILL RD
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2215
Practice Address - Country:US
Practice Address - Phone:856-795-5950
Practice Address - Fax:856-795-5951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25 MA 07299900207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F95304Medicare UPIN