Provider Demographics
NPI:1619998820
Name:GASTRO SPECIALISTS LLC
Entity type:Organization
Organization Name:GASTRO SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:HYMANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-634-1221
Mailing Address - Street 1:52 AMAGANSETT DR
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1184
Mailing Address - Country:US
Mailing Address - Phone:732-634-1221
Mailing Address - Fax:732-634-1290
Practice Address - Street 1:453 AMBOY AVE
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-2960
Practice Address - Country:US
Practice Address - Phone:732-634-1221
Practice Address - Fax:732-634-1290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05137100207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8221901Medicaid
NJ8221901Medicaid
NJF26622Medicare UPIN