Provider Demographics
NPI:1609917525
Name:GASTROENTEROLOGY CONSULTANTS OF SOUTH JERSEY PC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY CONSULTANTS OF SOUTH JERSEY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:KUTSCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-265-1700
Mailing Address - Street 1:693 MAIN STREET
Mailing Address - Street 2:PO BOX 70 BUILDING A SUITE 2
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048
Mailing Address - Country:US
Mailing Address - Phone:609-265-1700
Mailing Address - Fax:
Practice Address - Street 1:693 MAIN ST
Practice Address - Street 2:BUILDING A SUITE 2
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048-5043
Practice Address - Country:US
Practice Address - Phone:609-265-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ514870Medicare PIN