Provider Demographics
NPI:1033297890
Name:ASSOCIATED COLON & RECTAL SURGEONS, P.A.
Entity type:Organization
Organization Name:ASSOCIATED COLON & RECTAL SURGEONS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR,OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-494-6640
Mailing Address - Street 1:3900 PARK AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3032
Mailing Address - Country:US
Mailing Address - Phone:732-494-6640
Mailing Address - Fax:732-549-8204
Practice Address - Street 1:3900 PARK AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3032
Practice Address - Country:US
Practice Address - Phone:732-494-6640
Practice Address - Fax:732-549-8204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2641909Medicaid
NJ527583Medicare ID - Type Unspecified