Provider Demographics
NPI:1578009965
Name:GK HEALTH, PC
Entity Type:Organization
Organization Name:GK HEALTH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:ABRINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-787-0568
Mailing Address - Street 1:100 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KEANSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:07734-1725
Mailing Address - Country:US
Mailing Address - Phone:732-787-0568
Mailing Address - Fax:732-787-0270
Practice Address - Street 1:100 MAIN ST
Practice Address - Street 2:
Practice Address - City:KEANSBURG
Practice Address - State:NJ
Practice Address - Zip Code:07734-1725
Practice Address - Country:US
Practice Address - Phone:732-787-0568
Practice Address - Fax:732-787-0270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09476100207R00000X
NJ25MA09474900207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0642011Medicaid