Provider Demographics
NPI:1629022264
Name:ALLIED GASTROINTESTINAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:ALLIED GASTROINTESTINAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:VOLLMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-547-1661
Mailing Address - Street 1:217 WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1703
Mailing Address - Country:US
Mailing Address - Phone:856-547-1661
Mailing Address - Fax:856-547-6117
Practice Address - Street 1:217 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1703
Practice Address - Country:US
Practice Address - Phone:856-547-1661
Practice Address - Fax:856-547-6117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB04369000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6647804Medicaid
NJ680359Medicare PIN
NJ6647804Medicaid