Provider Demographics
NPI:1790910487
Name:ADVANCED GASTROENTEROLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:ADVANCED GASTROENTEROLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TENDLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-972-2220
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-0309
Mailing Address - Country:US
Mailing Address - Phone:732-972-2220
Mailing Address - Fax:
Practice Address - Street 1:3701 US HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-3396
Practice Address - Country:US
Practice Address - Phone:732-972-2220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-25
Last Update Date:2009-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05484900207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty