Provider Demographics
NPI:1801926209
Name:NORTHEAST GASTROENTEROLOGY ASSOCIATES INC
Entity type:Organization
Organization Name:NORTHEAST GASTROENTEROLOGY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-333-1776
Mailing Address - Street 1:2000 GRANT AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-4378
Mailing Address - Country:US
Mailing Address - Phone:215-333-1776
Mailing Address - Fax:215-333-0653
Practice Address - Street 1:2000 GRANT AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19115-4378
Practice Address - Country:US
Practice Address - Phone:215-333-1776
Practice Address - Fax:215-333-0653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty