=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578565552
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GASTROINTESTINAL GROUP OF NORTH JERSEY PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2005
-----------------------------------------------------
Last Update Date | 04/10/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1777 HAMBURG TURNPIKE SUITE 305
-----------------------------------------------------
City | WAYNE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07470
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-839-6400
-----------------------------------------------------
Fax | 973-839-7083
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1777 HAMBURG TURNPIKE SUITE 305
-----------------------------------------------------
City | WAYNE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07470
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-839-6400
-----------------------------------------------------
Fax | 973-839-7083
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | ROBERT D SHLIEN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 973-839-6400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------