Organization
GARDEN STATE GASTROENTEROLOGY,PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TRACEY DREVELUS HOM (OFFICE MANAGER)
(732) 525-0600
Entity
Organization
Contact information
Practice address
200 PERRINE RD, SUITE 231, OLD BRIDGE, NJ 08857-2842
(732) 525-0600
(732) 525-9777
Mailing address
PO BOX 209, WICKATUNK, NJ 07765-0209
(732) 525-0600
(732) 525-9777
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
MA59602
NJ
Other
Enumeration date
10/01/2007
Last updated
10/01/2007
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