Provider Demographics
NPI:1437101730
Name:GASTFRIEND, ROBERT JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JAY
Last Name:GASTFRIEND
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 1:16 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:PA
Mailing Address - Zip Code:19046-4263
Mailing Address - Country:US
Mailing Address - Phone:215-379-6789
Mailing Address - Fax:215-379-5510
Practice Address - Street 1:16 SHADY LN
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:PA
Practice Address - Zip Code:19046-4263
Practice Address - Country:US
Practice Address - Phone:215-379-6789
Practice Address - Fax:215-379-5510
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031235E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0085917000OtherKEYSTONE
PA001086912003Medicaid
PA164051OtherHIGHMARK BLUE SHIELD
PA55207OtherAETNA
PA0085917000OtherKEYSTONE
PA001086912003Medicaid