Basic Information
| Provider Information | |||||||||
| NPI: | 1679591028 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIGESTIVE CARE OF NEW JERSEY, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 71 UNION AVE | ||||||||
| Address2: | |||||||||
| City: | RUTHERFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070701274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018420020 | ||||||||
| FaxNumber: | 2018420010 | ||||||||
| Practice Location | |||||||||
| Address1: | 71 UNION AVE | ||||||||
| Address2: | |||||||||
| City: | RUTHERFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070701274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018420020 | ||||||||
| FaxNumber: | 2018420010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 12/14/2010 | ||||||||
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| AuthorizedOfficialLastName: | ROTH | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2018420020 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 6463801 | 05 | NJ | MEDICAID | CA4412 | 01 | RAILROAD MEDICARE | OTHER |