Provider Demographics
NPI:1407013188
Name:DRS. GARDINER & DITURI, PA
Entity Type:Organization
Organization Name:DRS. GARDINER & DITURI, PA
Other - Org Name:DRS. GARDINER & DITURI, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GARDINER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-741-5533
Mailing Address - Street 1:59 AVENUE AT THE COMMON
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702
Mailing Address - Country:US
Mailing Address - Phone:732-741-5533
Mailing Address - Fax:732-741-6064
Practice Address - Street 1:59 AVENUE AT THE COMMON
Practice Address - Street 2:SUITE 205
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702
Practice Address - Country:US
Practice Address - Phone:732-741-5533
Practice Address - Fax:732-741-6064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental