Provider Demographics
NPI:1023380037
Name:GATEWAY TO HEALTH
Entity Type:Organization
Organization Name:GATEWAY TO HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRABKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RRT RPSGT
Authorized Official - Phone:973-330-5899
Mailing Address - Street 1:1360 CLIFTON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1453
Mailing Address - Country:US
Mailing Address - Phone:973-330-5899
Mailing Address - Fax:973-416-9861
Practice Address - Street 1:30 HADLEY AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011
Practice Address - Country:US
Practice Address - Phone:973-330-5899
Practice Address - Fax:973-416-9861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ43ZA00309400332BX2000X
NJ1676821332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies