Provider Demographics
NPI:1366772014
Name:SOMERSET GASTROENTEROLOGY
Entity type:Organization
Organization Name:SOMERSET GASTROENTEROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SKOLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-566-6716
Mailing Address - Street 1:949 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-3349
Mailing Address - Country:US
Mailing Address - Phone:908-566-6716
Mailing Address - Fax:
Practice Address - Street 1:949 RIVER RD
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-3349
Practice Address - Country:US
Practice Address - Phone:908-566-6716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08006700207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
164653Medicare UPIN
104839M9VMedicare PIN