Healthcare Provider Details

I. General information

NPI: 1033297890
Provider Name (Legal Business Name): ASSOCIATED COLON & RECTAL SURGEONS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 06/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 PARK AVE SUITE 101
EDISON NJ
08820-3032
US

IV. Provider business mailing address

3900 PARK AVE SUITE 101
EDISON NJ
08820-3032
US

V. Phone/Fax

Practice location:
  • Phone: 732-494-6640
  • Fax: 732-549-8204
Mailing address:
  • Phone: 732-494-6640
  • Fax: 732-549-8204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2641909
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: DR. GREGORY OLIVER
Title or Position: DOCTOR,OWNER
Credential: MD
Phone: 732-494-6640