Provider Demographics
NPI:1801849708
Name:GASTROENTEROLOGY ASSOCIATES OF OCEAN COUNTY PA
Entity type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES OF OCEAN COUNTY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-886-1007
Mailing Address - Street 1:475 ROUTE 70
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5897
Mailing Address - Country:US
Mailing Address - Phone:732-886-1007
Mailing Address - Fax:732-886-0807
Practice Address - Street 1:475 ROUTE 70
Practice Address - Street 2:SUITE 103
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5897
Practice Address - Country:US
Practice Address - Phone:732-886-1007
Practice Address - Fax:732-886-0807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6231101Medicaid
NJDC2089OtherRAILROAD MEDICARE
NJ6231101Medicaid