Provider Demographics
NPI:1689728479
Name:AFFILIATES IN GASTROENTEROLOGY PA
Entity Type:Organization
Organization Name:AFFILIATES IN GASTROENTEROLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAMACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-731-4600
Mailing Address - Street 1:101 OLD SHORT HILLS RD
Mailing Address - Street 2:SUITE 217
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1000
Mailing Address - Country:US
Mailing Address - Phone:973-731-4600
Mailing Address - Fax:973-731-0525
Practice Address - Street 1:101 OLD SHORT HILLS RD
Practice Address - Street 2:SUITE 217
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1000
Practice Address - Country:US
Practice Address - Phone:973-731-4600
Practice Address - Fax:973-731-0525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJAF527166Medicare PIN