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Contact Information

SPARTA GASTROENTEROLOGY LLC
376 LAFAYETTE RD
SUITE 101
SPARTA TOWNSHIP, NJ07871
 Phone: 973-579-3174
 Fax: 973-579-2961
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Gastroenterology

207RG0100X 10 Physician/Gastroenterology
Indicates primary specialty

NPI Profile & details for SPARTA GASTROENTEROLOGY LLC

NPI # 1245424696
LBN Legal business name SPARTA GASTROENTEROLOGY LLC
Authorized official DMITRY MYSH - (MD OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 08/29/2007
Last updated 12/03/2007 - About 19 years ago
Identifiers
NJ License # 25MA065097
NJ Medicaid 8503206
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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