Provider Demographics
NPI:1962422295
Name:DIMARINO-KROOP-PRIETO GASTRO-INTESTINAL ASSOCIATES,PA
Entity type:Organization
Organization Name:DIMARINO-KROOP-PRIETO GASTRO-INTESTINAL ASSOCIATES,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JAMES
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 AVE
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 AVE
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA23137174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1996401Medicaid
NJE10277Medicare UPIN
NJ1996401Medicaid