MEDICARE: GASTROENTEROLOGY ASSOCIATES OF NEW JERSEY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207L00000X	Anesthesiology Physician
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician
3	363AM0700X	Medical Physician Assistant
4	363L00000X	Nurse Practitioner
5	207RG0100X	Gastroenterology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1945759	OTHER	NJ	AETNA HMO GROUP NUMBER
3	3533132000	OTHER	NJ	AMERIHEALTH GROUP NUMBER
4	9341206	OTHER	NJ	AETNA PPO GROUP NUMBER

General Provider Information

NPI Number	:	1497932271
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GASTROENTEROLOGY ASSOCIATES OF NEW JERSEY, LLC

Provider Business Mailing Address
First Line	:	1130 MCBRIDE AVE
Second Line	:
City	:	WOODLAND PARK
State	:	NJ
Zip	:	07424-3806
Country	:	US
Telephone Number	:	973-812-1400
Fax Number	:	973-812-1404

Provider Business Practice Location Address
First Line	:	1130 MCBRIDE AVE
Second Line	:
City	:	WOODLAND PARK
State	:	NJ
Zip	:	07424-3806
Country	:	US
Telephone Number	:	973-812-1400
Fax Number	:	973-812-1404

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	RACHEL ANDREANO
Credential	:
Telephone Number	:	973-785-2277

Provider Enumeration Date	:	01/24/2008
Last Update Date	:	08/09/2023

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