Healthcare Provider Details

I. General information

NPI: 1174735617
Provider Name (Legal Business Name): NORTH JERSEY DIGESTIVE HEALTHCARE P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 HAMBURG TURNPIKE
WAYNE NJ
07470
US

IV. Provider business mailing address

931 HAMBURG TURNPIKE
WAYNE NJ
07470
US

V. Phone/Fax

Practice location:
  • Phone: 973-628-7300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MICHELE DAMON
Title or Position: OFFICE MANAGER
Credential:
Phone: 973-628-7300