Organization
GASTROENTEROLOGY MEDICAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALAN PORT (DELEGATED OFFICIAL)
(201) 898-2849
Entity
Organization
Contact information
Practice address
9223 KENNEDY BLVD, SUITE D, NORTH BERGEN, NJ 07047-5322
(201) 868-2849
(201) 868-4190
Mailing address
9223 KENNEDY BLVD, SUITE D, NORTH BERGEN, NJ 07047-5322
(201) 868-2849
(201) 868-4190
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
25MA04429400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0182415
AETNA HMO GROUP #
NJ
01
—
0235258000
AMERIHEALTH GROUP #
NJ
01
—
2400229
GHI PPO GROUP #
NJ
01
—
4476564
AETNA PPO GROUP #
NJ
05
—
5529701
—
NJ
01
—
CL6517
RAILROAD MEDICARE GROUP #
NJ
Enumeration date
06/11/2006
Last updated
09/28/2007
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