Healthcare Provider Details

I. General information

NPI: 1851594519
Provider Name (Legal Business Name): GASTRO-SURGI CENTER OF NEW JERSEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 SPRUCE DRIVE
MOUNTAINSIDE NJ
07092
US

IV. Provider business mailing address

1132 SPRUCE DRIVE
MOUNTAINSIDE NJ
07092
US

V. Phone/Fax

Practice location:
  • Phone: 908-317-9434
  • Fax: 908-317-0103
Mailing address:
  • Phone: 908-317-9434
  • Fax: 908-317-0103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARVIN LIPSBY
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 908-317-9434