=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265524060
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JERSEY SHORE GASTROENTEROLOGY ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 408 BETHEL RD POINT COMMOMS, BLDG E
-----------------------------------------------------
City | SOMERS POINT
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08244-2172
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-926-3330
-----------------------------------------------------
Fax | 609-926-9033
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 408 BETHEL RD POINT COMMOMS, BLDG E
-----------------------------------------------------
City | SOMERS POINT
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08244-2172
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-926-3330
-----------------------------------------------------
Fax | 609-926-9033
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MGR
-----------------------------------------------------
Name | MRS. KAREN J PANZA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 609-926-3330
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------