Provider Demographics
NPI:1265524060
Name:JERSEY SHORE GASTROENTEROLOGY ASSOCIATES
Entity type:Organization
Organization Name:JERSEY SHORE GASTROENTEROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PANZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-926-3330
Mailing Address - Street 1:408 BETHEL RD
Mailing Address - Street 2:POINT COMMOMS, BLDG E
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2172
Mailing Address - Country:US
Mailing Address - Phone:609-926-3330
Mailing Address - Fax:609-926-9033
Practice Address - Street 1:408 BETHEL RD
Practice Address - Street 2:POINT COMMOMS, BLDG E
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2172
Practice Address - Country:US
Practice Address - Phone:609-926-3330
Practice Address - Fax:609-926-9033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ000207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0825353000OtherAMERIHEALTH
NJ5166004Medicaid
NJCG4454OtherRAILROAD MEDICARE
NJ119127OtherAETNA
NJCG4454OtherRAILROAD MEDICARE
NJ034519Medicare ID - Type UnspecifiedMEDICARE