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General NPI Number Information
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NPI Number | 1295141745
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Entity Type | Organization
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Legal Business Name | APEX GASTROENTEROLOGY, LLC
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Dates
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Enumeration Date | 07/05/2014
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Last Update Date | 06/12/2015
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Provider Practice Location Address
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Address Line | 501 IRON BRIDGE RD SUITE 9
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City | FREEHOLD
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State | NJ
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Zip | 07728-5304
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Country | US
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Telephone | 732-333-3747
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Fax |
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Provider Business Mailing Address
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Address Line | 501 IRON BRIDGE RD SUITE 9
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City | FREEHOLD
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State | NJ
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Zip | 07728-5304
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Country | US
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Telephone | 732-333-3747
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RADA SHAKOV
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Credential | MD
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Telephone | 732-333-3747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 25MA08359100
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License Number State | NJ
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