Provider Demographics
NPI:1689633588
Name:SOUTH JERSEY ENDOSCOPY LLC
Entity Type:Organization
Organization Name:SOUTH JERSEY ENDOSCOPY LLC
Other - Org Name:DIMARINO-KROOP-PRIETO GI ASSOC
Other - Org Type:Other Name
Authorized Official - Title/Position:ASC ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:I
Authorized Official - Last Name:CONN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-848-4464
Mailing Address - Street 1:26 EAST RED BANK AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1630
Mailing Address - Country:US
Mailing Address - Phone:856-848-4464
Mailing Address - Fax:856-848-7023
Practice Address - Street 1:26 EAST RED BANK AVE
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1630
Practice Address - Country:US
Practice Address - Phone:856-848-4464
Practice Address - Fax:856-848-7023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJAAAHC261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical