Provider Demographics
NPI:1679591028
Name:DIGESTIVE CARE OF NEW JERSEY, PA
Entity type:Organization
Organization Name:DIGESTIVE CARE OF NEW JERSEY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-842-0020
Mailing Address - Street 1:71 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-1274
Mailing Address - Country:US
Mailing Address - Phone:201-842-0020
Mailing Address - Fax:201-842-0010
Practice Address - Street 1:71 UNION AVE
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-1274
Practice Address - Country:US
Practice Address - Phone:201-842-0020
Practice Address - Fax:201-842-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6463801Medicaid
CA4412OtherRAILROAD MEDICARE
NJ6463801Medicaid