Provider Demographics
NPI:1841527637
Name:COLON & RECTAL SURGERY OF NORTH JERSEY, L.L.C.
Entity type:Organization
Organization Name:COLON & RECTAL SURGERY OF NORTH JERSEY, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:NIZIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-689-9100
Mailing Address - Street 1:140 CHESTNUT ST
Mailing Address - Street 2:SUITE NUMBER 301
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-2599
Mailing Address - Country:US
Mailing Address - Phone:201-689-9100
Mailing Address - Fax:
Practice Address - Street 1:140 CHESTNUT ST
Practice Address - Street 2:SUITE NUMBER 301
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-2599
Practice Address - Country:US
Practice Address - Phone:201-689-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA44217208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7970404Medicaid
NJMAI0505803Medicaid
NJG95630Medicare UPIN
NJ7970404Medicaid
NJMAI0505803Medicaid
NJ160308BLQMedicare PIN
NJ526636Medicare PIN