Basic Information
| Provider Information | |||||||||
| NPI: | 1336225168 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RED BANK GASTROENTEROLOGY ASSOCIATES, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 365 BROAD ST | ||||||||
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| City: | RED BANK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077012150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7328424294 | ||||||||
| FaxNumber: | 7325301497 | ||||||||
| Practice Location | |||||||||
| Address1: | 365 BROAD ST | ||||||||
| Address2: | |||||||||
| City: | RED BANK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077012150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7328424294 | ||||||||
| FaxNumber: | 7325301497 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| LastUpdateDate: | 01/06/2014 | ||||||||
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| AuthorizedOfficialLastName: | HERRO | ||||||||
| AuthorizedOfficialFirstName: | JACQUELINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | HR BENEFITS AND COMPENSATION SPCLST | ||||||||
| AuthorizedOfficialTelephone: | 7328424294 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.