Provider Demographics
NPI:1811194459
Name:CENTRAL JERSEY GASTROENTEROLOGY PC
Entity Type:Organization
Organization Name:CENTRAL JERSEY GASTROENTEROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-246-1028
Mailing Address - Street 1:3 OLDEN RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2921
Mailing Address - Country:US
Mailing Address - Phone:732-246-1028
Mailing Address - Fax:732-246-1045
Practice Address - Street 1:85 RARITAN AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2439
Practice Address - Country:US
Practice Address - Phone:732-246-1028
Practice Address - Fax:732-246-1045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07748600207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ088169Medicare ID - Type Unspecified