Provider Demographics
NPI:1255366589
Name:GASTROMED HEALTHCARE, P.A.
Entity type:Organization
Organization Name:GASTROMED HEALTHCARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-231-1999
Mailing Address - Street 1:286 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-3006
Mailing Address - Country:US
Mailing Address - Phone:908-231-1999
Mailing Address - Fax:908-231-1612
Practice Address - Street 1:286 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-3006
Practice Address - Country:US
Practice Address - Phone:908-231-1999
Practice Address - Fax:908-231-1612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ069048Medicare ID - Type Unspecified