MEDICARE: DIMARINO-KROOP-PRIETO GASTRO INTESTINAL ASSOCIATES PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist		NJ

General Provider Information

NPI Number	:	1104888080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIMARINO-KROOP-PRIETO GASTRO INTESTINAL ASSOCIATES PA

Provider Business Mailing Address
First Line	:	26 EAST RED BANK AVENUE
Second Line	:
City	:	WOODBURY
State	:	NJ
Zip	:	08096-1630
Country	:	US
Telephone Number	:	856-848-4464
Fax Number	:	856-848-7023

Provider Business Practice Location Address
First Line	:	26 EAST RED BANK AVENUE
Second Line	:
City	:	WOODBURY
State	:	NJ
Zip	:	08096-1630
Country	:	US
Telephone Number	:	856-848-4464
Fax Number	:	856-848-7023

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANTHONY J DIMARINO JR.
Credential	:	MD
Telephone Number	:	856-848-4464

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	08/18/2009

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