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General NPI Number Information
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NPI Number | 1306862883
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Entity Type | Organization
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Legal Business Name | NORTH JERSEY GASTROENTEROLOGY ASSOCIATES, P.A.
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 07/07/2016
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Provider Practice Location Address
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Address Line | 1500 PLEASANT VALLEY WAY SUITE 306
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City | WEST ORANGE
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State | NJ
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Zip | 07052-2956
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Country | US
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Telephone | 973-325-5775
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Fax | 973-325-5770
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Provider Business Mailing Address
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Address Line | 1500 PLEASANT VALLEY WAY SUITE 306
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City | WEST ORANGE
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State | NJ
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Zip | 07052-2956
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Country | US
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Telephone | 973-325-5775
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Fax | 973-325-5770
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. STEVEN CRAIG FISKE
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Credential | M.D.
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Telephone | 973-325-5775
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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 | MA34473
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License Number State | NJ
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