Advanced Gastroenterology, Pa

NPI 1164739447 - Internal Medicine - 207RG0100X

NPI Details
NPI 1164739447
Enumeration Date 09/08/2010
Last Updated 09/08/2010
Entity Type Healthcare Provider
Active Over 6 years ago
Authorized Information
Name GLEN R GLEN
Position OWNER
Phone (973) 731-8686
Fax (973) 731-1911
Practice Location
741 NORTHFIELD AVENUE
SUITE 204
WEST ORANGE NJ, 07052, US
Phone (973) 731-8686
Fax (973) 731-1911
Business Location
741 NORTHFIELD AVENUE
SUITE 204
WEST ORANGE NJ, 07052, US
Phone (973) 731-8686
Fax (973) 731-1911
Toxanomy
Taxonomy Code 207RG0100X
License State New Jersey
License Number 25MA037333
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According to our database, Advanced Gastroenterology, Pa NPI is 1164739447, taxonomy code is 207RG0100X and license number is 25MA037333, license state is located at New Jersey. Advanced Gastroenterology, Pa physically located at 741 Northfield Avenue, West Orange NJ, 07052. NPI Number 1033115704 has the healthcare provider type.

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1164739447 NPI number is provided on an as is basis without warranty of any kind. 1164739447 is maintained by the National Plan & Provider Enumeration System. The contents of Advanced Gastroenterology, Pa are for informational purposes only.