Provider Demographics
NPI:1811206667
Name:RIVERVIEW GASTROENTEROLOGY, LLC
Entity Type:Organization
Organization Name:RIVERVIEW GASTROENTEROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:DITTAMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-969-2111
Mailing Address - Street 1:935 RIVER RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-2234
Mailing Address - Country:US
Mailing Address - Phone:201-969-2111
Mailing Address - Fax:201-969-8015
Practice Address - Street 1:935 RIVER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-2234
Practice Address - Country:US
Practice Address - Phone:201-969-2111
Practice Address - Fax:201-969-8015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty