South Jersey Endoscopy LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

AAAHC Issued in NJ

Legal business name

SOUTH JERSEY ENDOSCOPY LLC

Practice address

26 East Red Bank Ave
Woodbury, NJ 08096-1630

Phone

(856) 848-4464

Fax

(856) 848-7023

NPI assigned

Mar 20, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Mitchell I Conn, MDNPI 1922067917

Title

ASC Administrator

Phone

(856) 848-4464

Specialties & licenses 1

Addresses

Other names 1

• DIMARINO-KROOP-PRIETO GI ASSOC Other name

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Listed as

South Jersey Endoscopy LLCCCN 31C0001059

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Dimarino-Kroop-Prieto Gastro Intestinal Associates PA

  • Specialist
  • Woodbury, NJ
  • NPI 1104888080

  Member Of

  NPD member

Locations

Practitioners 1

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

• Mitchell I. Conn, M.D.

  • Gastroenterology Physician
  • Phila, PA
  • NPI 1922067917
  NPD (past) Authorized official

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

{
    "created_epoch": "1142812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250553600000",
    "number": "1689633588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 EAST RED BANK AVE",
            "city": "WOODBURY",
            "state": "NJ",
            "postal_code": "080961630",
            "telephone_number": "856-848-4464",
            "fax_number": "856-848-7023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26 EAST RED BANK AVE",
            "city": "WOODBURY",
            "state": "NJ",
            "postal_code": "080961630",
            "telephone_number": "856-848-4464",
            "fax_number": "856-848-7023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH JERSEY ENDOSCOPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-20",
        "last_updated": "2009-08-18",
        "status": "A",
        "authorized_official_last_name": "CONN",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "ASC  ADMINISTRATOR",
        "authorized_official_telephone_number": "856-848-4464",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NJ",
            "license": "AAAHC",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DIMARINO-KROOP-PRIETO GI ASSOC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jennifer Lynne Smith, ATC
• Sylwester Mieczyslaw Sobieszczyk, M.D.
• Rachel Sole, EDD, LAC, NCC
• Morton Daniel Sosland, M.D.
• South Jersey Anesthesia and Pain Physicians PC
• Susan Speranza, LCSW
• Spine Bone and Joint Specialists LLC
• Salvatore Spitalieri Jr., ATC
• Morgan Spivak, LSW
• Sabina Rose Squillace, LPC

• All providers in Woodbury, NJ
• Ambulatory Surgical Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2009; 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.