Provider Demographics
NPI:1336225168
Name:RED BANK GASTROENTEROLOGY ASSOCIATES, PA
Entity Type:Organization
Organization Name:RED BANK GASTROENTEROLOGY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR BENEFITS AND COMPENSATION SPCLST
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-842-4294
Mailing Address - Street 1:365 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-2150
Mailing Address - Country:US
Mailing Address - Phone:732-842-4294
Mailing Address - Fax:732-530-1497
Practice Address - Street 1:365 BROAD ST
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2150
Practice Address - Country:US
Practice Address - Phone:732-842-4294
Practice Address - Fax:732-530-1497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJRE484209Medicare UPIN