Provider Demographics
NPI:1891881926
Name:GASTRO-SURGI CENTER OF NEW JERSEY
Entity Type:Organization
Organization Name:GASTRO-SURGI CENTER OF NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:A
Authorized Official - Last Name:GELARDI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
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:07092-2219
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:07092-2219
Practice Address - Country:US
Practice Address - Phone:908-317-9434
Practice Address - Fax:908-317-5874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJASC22511OtherSTATE LIC AMBULATORY SURG
NJ0061590Medicaid
NJASC22511OtherSTATE LIC AMBULATORY SURG