Provider Demographics
NPI:1497721823
Name:GIMOVSKY, MARTIN L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:L
Last Name:GIMOVSKY
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 1:1204 JOHNSTON DR
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-6419
Mailing Address - Country:US
Mailing Address - Phone:908-322-7028
Mailing Address - Fax:908-322-4998
Practice Address - Street 1:201 LYONS AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2027
Practice Address - Country:US
Practice Address - Phone:973-926-4787
Practice Address - Fax:973-923-7497
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07246600207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8595607Medicaid
050093NSVMedicare ID - Type Unspecified
NJ8595607Medicaid