Provider Demographics
NPI:1912131970
Name:ATLANTIC GASTRO SURGI CENTER T/A ACCESS
Entity Type:Organization
Organization Name:ATLANTIC GASTRO SURGI CENTER T/A ACCESS
Other - Org Name:ACCESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DELNERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-407-1220
Mailing Address - Street 1:3205 FIRE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5884
Mailing Address - Country:US
Mailing Address - Phone:609-407-1113
Mailing Address - Fax:609-407-0330
Practice Address - Street 1:3205 FIRE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-5884
Practice Address - Country:US
Practice Address - Phone:609-407-1113
Practice Address - Fax:609-407-0330
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC GASTROENTEROLOGY ASSOCIATES PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22935261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ311083Medicare PIN