Provider Demographics
NPI:1447244793
Name:GURNEY, JAN (DO)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:
Last Name:GURNEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JAN
Other - Middle Name:
Other - Last Name:AQUILINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:317 N GASTON AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-1714
Mailing Address - Country:US
Mailing Address - Phone:386-466-8629
Mailing Address - Fax:
Practice Address - Street 1:317 N GASTON AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-1714
Practice Address - Country:US
Practice Address - Phone:386-466-8629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB11729700207Q00000X
NY222891207Q00000X
FLOS 8854207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267427100Medicaid
FL267427100Medicaid
FLU1192ZMedicare PIN