Provider Demographics
NPI:1295141745
Name:APEX GASTROENTEROLOGY, LLC
Entity type:Organization
Organization Name:APEX GASTROENTEROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RADA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAKOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-333-3747
Mailing Address - Street 1:501 IRON BRIDGE RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-5304
Mailing Address - Country:US
Mailing Address - Phone:732-333-3747
Mailing Address - Fax:
Practice Address - Street 1:501 IRON BRIDGE RD
Practice Address - Street 2:SUITE 9
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-5304
Practice Address - Country:US
Practice Address - Phone:732-333-3747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-05
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08359100207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1295141745Medicare PIN