Provider Demographics
NPI:1841361441
Name:DIGESTIVE DISEASE CENTER OF NEW JERSEY, LLC
Entity type:Organization
Organization Name:DIGESTIVE DISEASE CENTER OF NEW JERSEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:RAPISARDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-238-0923
Mailing Address - Street 1:33 CLYDE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-5032
Mailing Address - Country:US
Mailing Address - Phone:732-873-9200
Mailing Address - Fax:732-873-1699
Practice Address - Street 1:800 RYDERS LN
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5849
Practice Address - Country:US
Practice Address - Phone:732-238-0923
Practice Address - Fax:732-257-0229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06451300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTAX ID#