Healthcare Provider Details

I. General information

NPI: 1811977705
Provider Name (Legal Business Name): SOUTHERN GASTRO ASSOCIATES OF NEW JERSEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 02/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 KINGS HWY
SWEDESBORO NJ
08085-3217
US

IV. Provider business mailing address

PO BOX 62
SWEDESBORO NJ
08085-0062
US

V. Phone/Fax

Practice location:
  • Phone: 856-467-0390
  • Fax: 856-467-9747
Mailing address:
  • Phone: 856-467-0390
  • Fax: 856-467-9747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA06255100
License Number StateNJ

VIII. Authorized Official

Name: DR. KIRIT I CHHAYA
Title or Position: PARTNER
Credential: MD
Phone: 856-467-0390