Provider Demographics
NPI:1851594519
Name:GASTRO-SURGI CENTER OF NEW JERSEY
Entity Type:Organization
Organization Name:GASTRO-SURGI CENTER OF NEW JERSEY
Other - Org Name:THE GASTRO-SURGI CENTER GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPSBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-317-9434
Mailing Address - Street 1:1132 SPRUCE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092
Mailing Address - Country:US
Mailing Address - Phone:908-317-9434
Mailing Address - Fax:908-317-0103
Practice Address - Street 1:1132 SPRUCE DRIVE
Practice Address - Street 2:
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092
Practice Address - Country:US
Practice Address - Phone:908-317-9434
Practice Address - Fax:908-317-0103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22511OtherASC
NJ0061590Medicaid
NJ026570Medicare ID - Type Unspecified