Provider Demographics
NPI:1093851560
Name:SOLITARE, GILBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:
Last Name:SOLITARE
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 1:279 3RD AVE
Mailing Address - Street 2:PO BOX 417
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-6205
Mailing Address - Country:US
Mailing Address - Phone:732-229-8711
Mailing Address - Fax:732-229-0245
Practice Address - Street 1:279 3RD AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6205
Practice Address - Country:US
Practice Address - Phone:732-229-8711
Practice Address - Fax:732-229-0245
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA26631291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5471800Medicaid
NJB10753Medicare UPIN
NJ5471800Medicaid