Provider Demographics
NPI:1083695258
Name:GUTKIN, MICHAEL S (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:GUTKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254B MOUNTAIN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-2413
Mailing Address - Country:US
Mailing Address - Phone:908-684-5800
Mailing Address - Fax:908-684-5606
Practice Address - Street 1:254B MOUNTAIN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2413
Practice Address - Country:US
Practice Address - Phone:908-684-5800
Practice Address - Fax:908-684-5606
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07353600208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9042806Medicaid
NJ056278VAHMedicare PIN
NJ9042806Medicaid