Healthcare Provider Details

I. General information

NPI: 1033196381
Provider Name (Legal Business Name): HACKENSACK DIGESTIVE DISEASE ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 08/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 1ST ST
HACKENSACK NJ
07601-2044
US

IV. Provider business mailing address

52 1ST ST
HACKENSACK NJ
07601-2044
US

V. Phone/Fax

Practice location:
  • Phone: 201-488-3003
  • Fax: 201-488-6911
Mailing address:
  • Phone: 201-488-3003
  • Fax: 201-488-6911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

# 1
Identifier1033196381
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerNPI

VIII. Authorized Official

Name: DR. RICHARD C GOLDING
Title or Position: PRESIDENT
Credential: M.D.
Phone: 201-488-3003