Provider Demographics
NPI:1861956971
Name:NEW AGE GASTROENTEROLOGY, INC.
Entity type:Organization
Organization Name:NEW AGE GASTROENTEROLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BALDEOSINGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-654-2199
Mailing Address - Street 1:PO BOX 8126
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92375-1326
Mailing Address - Country:US
Mailing Address - Phone:909-654-2199
Mailing Address - Fax:909-798-8765
Practice Address - Street 1:245 E REDLANDS BLVD STE K
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3760
Practice Address - Country:US
Practice Address - Phone:909-654-2199
Practice Address - Fax:909-798-8765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty