Basic Information
| Provider Information | |||||||||
| NPI: | 1710045273 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PASSAIC COUNTY GASTROENTEROLOGY PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 BROWERTOWN ROAD | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | WEST PATERSON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738370230 | ||||||||
| FaxNumber: | 9738370234 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 BROWERTOWN ROAD | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | WEST PATERSON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738370230 | ||||||||
| FaxNumber: | 9738370234 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | OSTRANDER | ||||||||
| AuthorizedOfficialFirstName: | PAT | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9738370230 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.