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General NPI Number Information
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NPI Number | 1447558655
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Entity Type | Organization
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Legal Business Name | NEW JERSEY ADVANCED GASTROENTEROLOGY, LLC
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Dates
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Enumeration Date | 03/11/2011
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Last Update Date | 12/26/2012
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Provider Practice Location Address
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Address Line | 1225 MCBRIDE AVE SUITE 200
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City | WOODLAND PARK
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State | NJ
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Zip | 07424-2540
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Country | US
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Telephone | 973-638-1740
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Fax |
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Provider Business Mailing Address
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Address Line | 1225 MCBRIDE AVE SUITE 200
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City | WOODLAND PARK
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State | NJ
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Zip | 07424-2540
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Country | US
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Telephone | 973-638-1740
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. SOHAIL N SHAIKH
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Credential | MD
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Telephone | 973-638-1740
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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 | 25MA07916100
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License Number State | NJ
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