Provider Demographics
NPI:1639116973
Name:BIGORNIA, EDGAR G (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:G
Last Name:BIGORNIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 CORTLAND DR
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-4024
Mailing Address - Country:US
Mailing Address - Phone:732-349-4422
Mailing Address - Fax:732-349-8126
Practice Address - Street 1:477 LAKEHURST RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6342
Practice Address - Country:US
Practice Address - Phone:732-349-4422
Practice Address - Fax:732-349-8126
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06983100207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE8689407Medicaid
NJ031884Medicare ID - Type Unspecified
NE8689407Medicaid