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NPI Code Detail

MEDICARE: GASTRO SPECIALISTS LLC

MEDICARE: GASTRO SPECIALISTS LLC
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
1207RG0100XGastroenterology Physician25MB05137100NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

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

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Directions to “GASTRO SPECIALISTS LLC ” Practice Location

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