Provider Demographics
NPI:1669521126
Name:DIGESTIVE HEALTH AND NUTRITION CENTER, LLC
Entity type:Organization
Organization Name:DIGESTIVE HEALTH AND NUTRITION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:
Authorized Official - Last Name:ARLINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-390-1995
Mailing Address - Street 1:465 CRANBURY RD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-7600
Mailing Address - Country:US
Mailing Address - Phone:732-390-1995
Mailing Address - Fax:732-254-4610
Practice Address - Street 1:465 CRANBURY RD
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-7600
Practice Address - Country:US
Practice Address - Phone:732-390-1995
Practice Address - Fax:732-254-4610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ069432Medicare PIN
NJC59954Medicare UPIN
NJF06704Medicare UPIN