Healthcare Provider Details

I. General information

NPI: 1497874358
Provider Name (Legal Business Name): THE CENTER FOR GASTROENTEROLOGY AND LIVER DISORDERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 STATE RT 3 SUITE 210
SECAUCUS NJ
07094-3857
US

IV. Provider business mailing address

255 STATE RT 3 SUITE 210
SECAUCUS NJ
07094-3857
US

V. Phone/Fax

Practice location:
  • Phone: 201-866-2400
  • Fax: 201-866-0444
Mailing address:
  • Phone: 201-866-2400
  • Fax: 201-866-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMA50168
License Number StateNJ

VIII. Authorized Official

Name: WAYNE D SIEGEL
Title or Position: PRESIDENT
Credential: MD
Phone: 201-866-2400