Provider Demographics
NPI:1215995923
Name:CENTER FOR DIGESTIVE DISEASES, P.A.
Entity type:Organization
Organization Name:CENTER FOR DIGESTIVE DISEASES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMIAPPAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTHUSAMY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-688-6565
Mailing Address - Street 1:695 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-9302
Mailing Address - Country:US
Mailing Address - Phone:908-688-6565
Mailing Address - Fax:908-688-3161
Practice Address - Street 1:695 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-9302
Practice Address - Country:US
Practice Address - Phone:908-688-6565
Practice Address - Fax:908-688-3161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3354202Medicaid
NJ3354202Medicaid