Provider Demographics
NPI:1700112737
Name:GASTROENTEROLOGY HEALTHCARE P.A.
Entity Type:Organization
Organization Name:GASTROENTEROLOGY HEALTHCARE P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MANZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-433-7600
Mailing Address - Street 1:799 BLOOMFIELD AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1301
Mailing Address - Country:US
Mailing Address - Phone:973-433-7600
Mailing Address - Fax:973-433-7462
Practice Address - Street 1:799 BLOOMFIELD AVE STE 102
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-1301
Practice Address - Country:US
Practice Address - Phone:973-433-7600
Practice Address - Fax:973-433-7462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03690300207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2095700Medicaid