Provider Demographics
NPI:1821564634
Name:ADVANCED GASTROENTEROLOGY OF NORTHERN NJ LLC
Entity Type:Organization
Organization Name:ADVANCED GASTROENTEROLOGY OF NORTHERN NJ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BERBERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-745-2241
Mailing Address - Street 1:15 ARKANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:OCEAN CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08226-2962
Mailing Address - Country:US
Mailing Address - Phone:609-382-0111
Mailing Address - Fax:201-255-0668
Practice Address - Street 1:15 ARKANSAS AVE
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:NJ
Practice Address - Zip Code:08226-2962
Practice Address - Country:US
Practice Address - Phone:609-382-0111
Practice Address - Fax:201-255-0668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-18
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA07878000OtherMEDICAL DOCTOR