Healthcare Provider Details

I. General information

NPI: 1043295017
Provider Name (Legal Business Name): ASSOCIATES IN GASTROENTEROLOGY OF UNION COUNTY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 NORTH AVE E
CRANFORD NJ
07016-2441
US

IV. Provider business mailing address

210 NORTH AVE E
CRANFORD NJ
07016-2441
US

V. Phone/Fax

Practice location:
  • Phone: 908-272-6300
  • Fax: 908-272-6302
Mailing address:
  • Phone: 908-272-6300
  • Fax: 908-272-6302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL LEONARD MARGOLIN
Title or Position: PRESIDENT
Credential: MD
Phone: 908-272-6300