Provider Demographics
NPI:1942267893
Name:GASTROENTEROLOGY DIAGNOSTICS OF NORTHERN NEW JERSEY, PA
Entity Type:Organization
Organization Name:GASTROENTEROLOGY DIAGNOSTICS OF NORTHERN NEW JERSEY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SNODGRASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:1A BURTON HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6187
Mailing Address - Country:US
Mailing Address - Phone:615-665-1283
Mailing Address - Fax:
Practice Address - Street 1:205 BROWERTOWN RD STE 102
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424-2610
Practice Address - Country:US
Practice Address - Phone:973-890-4780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ449095OtherCIGNA HEALTHCARE
NJ311075OtherBLUE CROSS BLUE SHIELD
NJ110129466OtherRAILROAD MEDICARE
NJA395291OtherOXFORD HEALTH PLANS
NJIL9983OtherHEALTHNET
NJ0574486OtherAETNA
NJ311405Medicare ID - Type Unspecified