Provider Demographics
NPI:1184778060
Name:MORRIS AVENUE ENDOSCOPY LLC
Entity type:Organization
Organization Name:MORRIS AVENUE ENDOSCOPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:E
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-241-8900
Mailing Address - Street 1:200 SHEFFIELD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-2315
Mailing Address - Country:US
Mailing Address - Phone:908-241-8900
Mailing Address - Fax:908-241-8933
Practice Address - Street 1:200 SHEFFIELD ST STE 101
Practice Address - Street 2:
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2315
Practice Address - Country:US
Practice Address - Phone:908-241-8900
Practice Address - Fax:908-241-8933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
22724207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9061801Medicaid
NJ3K3659OtherHEALTHNET
NJ9061801Medicaid
NJ058668Medicare PIN