Provider Demographics
NPI:1447497656
Name:GASTOENTEROLOGY OF NORTH ESSEX PC
Entity type:Organization
Organization Name:GASTOENTEROLOGY OF NORTH ESSEX PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CELEBRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-680-5500
Mailing Address - Street 1:199 BROAD ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2635
Mailing Address - Country:US
Mailing Address - Phone:973-680-5500
Mailing Address - Fax:
Practice Address - Street 1:199 BROAD ST
Practice Address - Street 2:STE 1A
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2635
Practice Address - Country:US
Practice Address - Phone:973-680-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA48682207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1835301Medicaid
NJ1835301Medicaid