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General NPI Number Information
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NPI Number | 1811977705
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Entity Type | Organization
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Legal Business Name | SOUTHERN GASTRO ASSOCIATES OF NEW JERSEY LLC
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Dates
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Enumeration Date | 01/18/2006
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Last Update Date | 02/24/2009
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Provider Practice Location Address
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Address Line | 2005 KINGS HWY
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City | SWEDESBORO
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State | NJ
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Zip | 08085-3217
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Country | US
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Telephone | 856-467-0390
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Fax | 856-467-9747
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Provider Business Mailing Address
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Address Line | PO BOX 62
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City | SWEDESBORO
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State | NJ
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Zip | 08085-0062
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Country | US
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Telephone | 856-467-0390
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Fax | 856-467-9747
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Authorized Official
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Title or Position | PARTNER
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Name | DR. KIRIT I CHHAYA
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Credential | MD
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Telephone | 856-467-0390
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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 | 25MA06255100
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License Number State | NJ
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