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General NPI Number Information
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NPI Number | 1619998820
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Entity Type | Organization
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Legal Business Name | GASTRO SPECIALISTS LLC
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 453 AMBOY AVE
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City | WOODBRIDGE
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State | NJ
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Zip | 07095-2960
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Country | US
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Telephone | 732-634-1221
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Fax | 732-634-1290
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Provider Business Mailing Address
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Address Line | 52 AMAGANSETT DR
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City | MORGANVILLE
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State | NJ
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Zip | 07751-1184
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Country | US
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Telephone | 732-634-1221
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Fax | 732-634-1290
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL T HYMANSON
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Credential | D.O.
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Telephone | 732-634-1221
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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 | 25MB05137100
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License Number State | NJ
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