NPIMap

Organization Active NPI

Morris Avenue Endoscopy LLC

  • Anesthesiology Physician
  • Mountainside, NJ
National Provider Identifier
1184778060
Registry record updated Sep 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
22724
Legal business name
MORRIS AVENUE ENDOSCOPY LLC
Practice address
200 Sheffield St Ste 101
Mountainside, NJ 07092-2315
Phone
(908) 241-8900
Fax
(908) 241-8933
NPI assigned
Jan 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ricardo E Rodriguez, MDNPI 1467471821
Title
Medical Director
Phone
(908) 241-8900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X 22724 Primary

Addresses

Primary practice location

200 Sheffield St Ste 101
Mountainside, NJ 07092-2315

Mailing address

200 Sheffield St Ste 101
Mountainside, NJ 07092-2315
Phone (908) 241-8900

Other identifiers 2

IdentifierTypeStateIssuer
9061801MedicaidNJ
3K3659OtherNJHEALTHNET

Other names 1

  • Garden State Endoscopy Anesthesia Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040902000513 NJ Part B Supplier - Clinic/Group Practice 8921074840 Receives reassigned benefits from 40 practitioners
Practice locations: Mountainside, NJ

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
31D1029355Garden State Endoscopy and200 Sheffield Street, Mountainside, NJ 07092Certificate of waiverAug 15, 2026

National Provider Directory

National Provider Directory
Tax ID family
Garden State Endoscopy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 54

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 54

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632787200000",
    "number": "1184778060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 SHEFFIELD ST STE 101",
            "city": "MOUNTAINSIDE",
            "state": "NJ",
            "postal_code": "070922315",
            "telephone_number": "908-241-8900",
            "fax_number": "908-241-8933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 SHEFFIELD ST STE 101",
            "city": "MOUNTAINSIDE",
            "state": "NJ",
            "postal_code": "070922315",
            "telephone_number": "908-241-8900",
            "fax_number": "908-241-8933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MORRIS AVENUE ENDOSCOPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2021-09-28",
        "certification_date": "2021-09-28",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "RICARDO",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "908-241-8900",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": "22724",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9061801",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "3K3659",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Garden State Endoscopy Anesthesia",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Garden State Endoscopy Anesthesia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mountainside, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.