Provider Demographics
NPI:1235192139
Name:GORE, CONSTANCE B (APN)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:B
Last Name:GORE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 MADISON AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-7354
Mailing Address - Country:US
Mailing Address - Phone:973-538-4870
Mailing Address - Fax:973-267-6880
Practice Address - Street 1:100 MADISON AVE
Practice Address - Street 2:CAROL G SIMON CANCER CENTER
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6136
Practice Address - Country:US
Practice Address - Phone:973-538-4870
Practice Address - Fax:973-267-6880
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN05253500363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0021733Medicaid
NJ026521C3WMedicare PIN
NJ0021733Medicaid
NJ026521BL0Medicare PIN