Healthcare Provider Details

I. General information

NPI: 1770705147
Provider Name (Legal Business Name): NORTH JERSEY DIGESTIVE ENDOSCOPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
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: KEVIN KEARNEY
Title or Position: PHYSICIAN
Credential:
Phone: 973-628-7300