MEDICARE: DIGESTIVE CARE OF NEW JERSEY, 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	207RG0100X	Gastroenterology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CA4412	OTHER		RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1679591028
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIGESTIVE CARE OF NEW JERSEY, PA

Provider Business Mailing Address
First Line	:	71 UNION AVE
Second Line	:
City	:	RUTHERFORD
State	:	NJ
Zip	:	07070-1274
Country	:	US
Telephone Number	:	201-842-0020
Fax Number	:	201-842-0010

Provider Business Practice Location Address
First Line	:	71 UNION AVE
Second Line	:
City	:	RUTHERFORD
State	:	NJ
Zip	:	07070-1274
Country	:	US
Telephone Number	:	201-842-0020
Fax Number	:	201-842-0010

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSEPH ROTH
Credential	:	M.D.
Telephone Number	:	201-842-0020

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	12/14/2010

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Directions to “DIGESTIVE CARE OF NEW JERSEY, PA ” Practice Location

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