Provider Demographics
NPI:1619900107
Name:ASSOCIATED GASTROENTEROLOGY OF CENTRAL NEW JERSEY, P.A.
Entity Type:Organization
Organization Name:ASSOCIATED GASTROENTEROLOGY OF CENTRAL NEW JERSEY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PICKOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-846-2777
Mailing Address - Street 1:81 VERONICA AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-3491
Mailing Address - Country:US
Mailing Address - Phone:732-846-2777
Mailing Address - Fax:
Practice Address - Street 1:81 VERONICA AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-3491
Practice Address - Country:US
Practice Address - Phone:732-846-2777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA05828700207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTAX IDENTIFICATION
NJ434274Medicare PIN