Provider Demographics
NPI:1790971729
Name:UNIVERSITY GASTROENTEROLOGY AND HEPATOLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:UNIVERSITY GASTROENTEROLOGY AND HEPATOLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-955-3947
Mailing Address - Street 1:132 S 10TH ST
Mailing Address - Street 2:480 MAIN BUILDING
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5244
Mailing Address - Country:US
Mailing Address - Phone:215-955-8900
Mailing Address - Fax:215-955-5245
Practice Address - Street 1:443 LAUREL OAK RD
Practice Address - Street 2:SUITE 230
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4451
Practice Address - Country:US
Practice Address - Phone:215-955-8900
Practice Address - Fax:215-955-5245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0131512Medicaid
NJ0131512Medicaid