Provider Demographics
NPI:1619054392
Name:ADVANCED GASTROINTESTINAL SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:ADVANCED GASTROINTESTINAL SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:T
Authorized Official - Last Name:MERLIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-772-1600
Mailing Address - Street 1:2301 E EVESHAM RD
Mailing Address - Street 2:BUILDING 800 SUITE 110
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4501
Mailing Address - Country:US
Mailing Address - Phone:856-772-1600
Mailing Address - Fax:856-772-9031
Practice Address - Street 1:2301 E EVESHAM RD
Practice Address - Street 2:BUILDING 800 SUITE 110
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4501
Practice Address - Country:US
Practice Address - Phone:856-772-1600
Practice Address - Fax:856-772-9031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0120375Medicaid
NJDF3606OtherMEDICARE RR
106101Medicare PIN