Organization
MIDDLESEX MONMOUTH GASTROENTEROLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN DEBARD MPA (ADMINISTRATOR)
(732) 577-1999
Entity
Organization
Contact information
Practice address
222 SCHANCK RD STE 302, FREEHOLD, NJ 07728-2974
(732) 577-1999
(732) 845-5356
Mailing address
222 SCHANCK RD STE 302, FREEHOLD, NJ 07728-2974
(732) 577-1999
(732) 845-5356
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
NJ
207RG0100X
Gastroenterology Physician
Primary
—
—
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31D0124927
CLIA
NJ
01
—
583237
MEDICARE GROUP ID- MIDDLESEX COUNTY OFFICES
NJ
05
—
7110901
—
NJ
Enumeration date
12/12/2006
Last updated
03/29/2012
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