Healthcare Provider Details

I. General information

NPI: 1477599322
Provider Name (Legal Business Name): GASTROENTEROLOGY ASSOC. OF NORTH JERSEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 W BLACKWELL ST
DOVER NJ
07801-2560
US

IV. Provider business mailing address

369 W BLACKWELL ST
DOVER NJ
07801-2560
US

V. Phone/Fax

Practice location:
  • Phone: 973-361-7660
  • Fax: 973-361-0455
Mailing address:
  • Phone: 973-361-7660
  • Fax: 973-361-0455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BARRY S. BENEROFE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 973-361-7660