Provider Demographics
NPI:1851525661
Name:NJ GASTRO, LLC
Entity Type:Organization
Organization Name:NJ GASTRO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOMENICA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:BARRITTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-645-0000
Mailing Address - Street 1:24 MERCHANT ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-2847
Mailing Address - Country:US
Mailing Address - Phone:973-645-0000
Mailing Address - Fax:
Practice Address - Street 1:24 MERCHANT ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-2847
Practice Address - Country:US
Practice Address - Phone:972-645-0000
Practice Address - Fax:973-645-0001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-07
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207RG0100X
207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ154390Medicare PIN
NJDQ6126Medicare PIN