Basic Information
| Provider Information | |||||||||
| NPI: | 1912131970 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ATLANTIC GASTRO SURGI CENTER T/A ACCESS | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | ACCESS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3205 FIRE RD | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | EGG HARBOR TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082345884 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094071113 | ||||||||
| FaxNumber: | 6094070330 | ||||||||
| Practice Location | |||||||||
| Address1: | 3205 FIRE RD | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | EGG HARBOR TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082345884 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094071113 | ||||||||
| FaxNumber: | 6094070330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2009 | ||||||||
| LastUpdateDate: | 05/06/2009 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DELNERO | ||||||||
| AuthorizedOfficialFirstName: | JAN | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6094071220 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ATLANTIC GASTROENTEROLOGY ASSOCIATES PA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 22935 | NJ | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.