MEDICARE: PRINCETON GASTROENTEROLOGY ASSOC

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	207RG0100X	Gastroenterology Physician		NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	57811	OTHER	AETNA
2	0821011000	OTHER	AMERIHEALTH
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396746962
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRINCETON GASTROENTEROLOGY ASSOC

Provider Business Mailing Address
First Line	:	731 ALEXANDER RD
Second Line	:	SUITE 100
City	:	PRINCETON
State	:	NJ
Zip	:	08540-6345
Country	:	US
Telephone Number	:	609-924-1422
Fax Number	:	609-924-7473

Provider Business Practice Location Address
First Line	:	731 ALEXANDER RD
Second Line	:	SUITE 100
City	:	PRINCETON
State	:	NJ
Zip	:	08540-6345
Country	:	US
Telephone Number	:	609-924-1422
Fax Number	:	609-924-7473

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GLENN OSIAS
Credential	:	MD
Telephone Number	:	609-924-1422

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/21/2022

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Directions to “PRINCETON GASTROENTEROLOGY ASSOC ” Practice Location

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