Provider Demographics
NPI:1811977705
Name:SOUTHERN GASTRO ASSOCIATES OF NEW JERSEY LLC
Entity type:Organization
Organization Name:SOUTHERN GASTRO ASSOCIATES OF NEW JERSEY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRIT
Authorized Official - Middle Name:I
Authorized Official - Last Name:CHHAYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-467-0390
Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:SWEDESBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-0062
Mailing Address - Country:US
Mailing Address - Phone:856-467-0390
Mailing Address - Fax:856-467-9747
Practice Address - Street 1:2005 KINGS HWY
Practice Address - Street 2:
Practice Address - City:SWEDESBORO
Practice Address - State:NJ
Practice Address - Zip Code:08085-3217
Practice Address - Country:US
Practice Address - Phone:856-467-0390
Practice Address - Fax:856-467-9747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06255100207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJCK2336OtherRAILROAD MEDICARE
NJ7281803Medicaid
NJ895237Medicare PIN