Provider Demographics
NPI:1750459467
Name:HACKENSACK GASTROENTEROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:HACKENSACK GASTROENTEROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:LEIBOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-489-7772
Mailing Address - Street 1:130 KINDERKAMACK RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:RIVER EDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07661-1939
Mailing Address - Country:US
Mailing Address - Phone:201-489-7772
Mailing Address - Fax:201-489-7411
Practice Address - Street 1:130 KINDERKAMACK RD
Practice Address - Street 2:SUITE 301
Practice Address - City:RIVER EDGE
Practice Address - State:NJ
Practice Address - Zip Code:07661-1939
Practice Address - Country:US
Practice Address - Phone:201-489-7772
Practice Address - Fax:201-489-7411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ19460174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
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NJ1679585236OtherNPI NUMBER
NJ1053323600OtherNPI NUMBER
NJI44178Medicare UPIN
NJ1679585236OtherNPI NUMBER
NJ776486NT9Medicare ID - Type Unspecified
NJ1871505420OtherNPI NUMBER
NJ1316959976OtherNPI NUMBER
NJE59911Medicare UPIN
NJ1053323600OtherNPI NUMBER
NJ459860NT9Medicare ID - Type Unspecified