Organization
SPARTA GASTROENTEROLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DMITRY MYSH MD (MD OWNER)
(973) 579-3174
Entity
Organization
Contact information
Practice address
376 LAFAYETTE RD, SUITE 101, SPARTA, NJ 07871
(973) 579-3174
(973) 579-2961
Mailing address
376 LAFAYETTE RD, SUITE 101, SPARTA, NJ 07871-3560
(973) 579-3174
(973) 579-2961
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
25MA065097
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8503206
—
NJ
Enumeration date
08/29/2007
Last updated
12/03/2007
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