Provider Demographics
NPI:1104888080
Name:DIMARINO-KROOP-PRIETO GASTRO INTESTINAL ASSOCIATES PA
Entity type:Organization
Organization Name:DIMARINO-KROOP-PRIETO GASTRO INTESTINAL ASSOCIATES PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DIMARINO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:856-848-4464
Mailing Address - Street 1:26 EAST RED BANK AVENUE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1630
Mailing Address - Country:US
Mailing Address - Phone:856-848-4464
Mailing Address - Fax:856-848-7023
Practice Address - Street 1:26 EAST RED BANK AVENUE
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1630
Practice Address - Country:US
Practice Address - Phone:856-848-4464
Practice Address - Fax:856-848-7023
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIMARINO-KROOP-PRIETO GASTRO INTESTINAL ASSOCIATES PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-05
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ165712Medicare PIN