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General NPI Number Information
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NPI Number | 1245391051
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Entity Type | Organization
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Legal Business Name | GASTROENTEROLOGY GROUP OF SOUTH JERSEY P C
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 06/11/2008
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Provider Practice Location Address
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Address Line | 602 W SHERMAN AVE
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City | VINELAND
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State | NJ
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Zip | 08360-7054
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Country | US
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Telephone | 856-691-1400
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Fax | 856-691-7117
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Provider Business Mailing Address
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Address Line | 602 W SHERMAN AVE
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City | VINELAND
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State | NJ
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Zip | 08360-7054
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Country | US
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Telephone | 856-691-1400
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Fax | 856-691-7117
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Authorized Official
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Title or Position | OWNER
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Name | GARY MATUSOW
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Credential | DO
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Telephone | 856-691-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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