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General NPI Number Information
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NPI Number | 1801926209
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Entity Type | Organization
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Legal Business Name | NORTHEAST GASTROENTEROLOGY ASSOCIATES INC
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 03/09/2011
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Provider Practice Location Address
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Address Line | 2000 GRANT AVE SUITE 103
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City | PHILA
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State | PA
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Zip | 19115-4378
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Country | US
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Telephone | 215-333-1776
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Fax | 215-333-0653
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Provider Business Mailing Address
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Address Line | 2000 GRANT AVE SUITE 103
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City | PHILA
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State | PA
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Zip | 19115-4378
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Country | US
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Telephone | 215-333-1776
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Fax | 215-333-0653
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Authorized Official
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Title or Position | PRESIDENT
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Name | EUGENE M MAYER
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Credential | MD
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Telephone | 215-333-1776
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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 |
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License Number State |
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