Provider Demographics
NPI:1528267317
Name:CONSULTANT IN DIGESTIVE AND LIVER DISEASES
Entity type:Organization
Organization Name:CONSULTANT IN DIGESTIVE AND LIVER DISEASES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NASHED
Authorized Official - Middle Name:G
Authorized Official - Last Name:BOTROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-967-9595
Mailing Address - Street 1:37 BRUNSWICK WOODS DR
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5601
Mailing Address - Country:US
Mailing Address - Phone:732-967-9595
Mailing Address - Fax:733-296-7071
Practice Address - Street 1:37 BRUNSWICK WOODS DR
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5601
Practice Address - Country:US
Practice Address - Phone:732-967-9595
Practice Address - Fax:733-296-7071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA59776174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6290205Medicaid
NJF90707Medicare UPIN