Provider Demographics
NPI:1023296407
Name:GASTROINTESTINAL ASSOCIATES PA
Entity type:Organization
Organization Name:GASTROINTESTINAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOBEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-444-2600
Mailing Address - Street 1:140 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-2599
Mailing Address - Country:US
Mailing Address - Phone:201-444-2600
Mailing Address - Fax:201-444-9471
Practice Address - Street 1:140 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-2599
Practice Address - Country:US
Practice Address - Phone:201-444-2600
Practice Address - Fax:201-444-9471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJCF1672OtherRAILROAD MEDICARE
NJCF1672OtherRAILROAD MEDICARE