=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326136177
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TEANECK GASTROENTEROLOGY&ENDOSCOPY CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2006
-----------------------------------------------------
Last Update Date | 09/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1086 TEANECK RD SUITE 3B
-----------------------------------------------------
City | TEANECK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07666-4854
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-837-7728
-----------------------------------------------------
Fax | 201-578-1089
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1086 TEANECK RD SUITE 3B
-----------------------------------------------------
City | TEANECK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07666-4854
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-837-7728
-----------------------------------------------------
Fax | 201-578-1089
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | MRS. LINDA DIXON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 201-837-7728
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------