Provider Demographics
NPI:1447320213
Name:FREEHOLD ENDOSCOPY ASSOCIATES, LLC
Entity type:Organization
Organization Name:FREEHOLD ENDOSCOPY ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLANK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-845-0990
Mailing Address - Street 1:222 SCHANCK ROAD
Mailing Address - Street 2:STE 100
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728
Mailing Address - Country:US
Mailing Address - Phone:732-845-0990
Mailing Address - Fax:732-845-0088
Practice Address - Street 1:222 SCHANCK ROAD
Practice Address - Street 2:STE 100
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728
Practice Address - Country:US
Practice Address - Phone:732-845-0990
Practice Address - Fax:732-845-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID NUMBER
NJ080499Medicare ID - Type Unspecified