Basic Information
Provider Information
NPI: 1609803204
EntityType: 2
ReplacementNPI:  
OrganizationName: AFFILIATED ENDOSCOPY SERVICES OF CLIFTON LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
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Credential:  
OtherOrganizationName: AFFILIATED ENDOSCOPY SERVICES OF CLIFTON
OtherOrganizationType: 3
OtherLastName:  
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Mailing Information
Address1: 1A BURTON HILLS BLVD
Address2:  
City: NASHVILLE
State: TN
PostalCode: 372156187
CountryCode: US
TelephoneNumber: 6152403741
FaxNumber:  
Practice Location
Address1: 925 CLIFTON AVE
Address2: SUITE 100
City: CLIFTON
State: NJ
PostalCode: 070132724
CountryCode: US
TelephoneNumber: 9734580408
FaxNumber: 9734056564
Other Information
ProviderEnumerationDate: 06/27/2006
LastUpdateDate: 05/11/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: SNODGRASS
AuthorizedOfficialFirstName: JEFFREY
AuthorizedOfficialMiddleName: E.
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 6156651283
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/11/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QE0800X  N Ambulatory Health Care FacilitiesClinic/CenterEndoscopy
261QA1903X  Y Ambulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical

No ID Information.


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