Provider Demographics
NPI:1679512578
Name:ATLANTIC COAST GASTROENTEROLOGY ASSOCIATES
Entity type:Organization
Organization Name:ATLANTIC COAST GASTROENTEROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLACHTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-458-8300
Mailing Address - Street 1:1640 ROUTE 88 W
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3036
Mailing Address - Country:US
Mailing Address - Phone:732-458-8300
Mailing Address - Fax:732-458-8529
Practice Address - Street 1:1640 ROUTE 88 W
Practice Address - Street 2:SUITE 202
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3036
Practice Address - Country:US
Practice Address - Phone:732-458-8300
Practice Address - Fax:732-458-8529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7343108Medicaid
NJ807729Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER