Provider Demographics
NPI:1578666707
Name:GUTIN, FAINA M (MD)
Entity Type:Individual
Prefix:
First Name:FAINA
Middle Name:M
Last Name:GUTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:630 SALEM AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096
Mailing Address - Country:US
Mailing Address - Phone:856-845-8300
Mailing Address - Fax:856-845-2512
Practice Address - Street 1:570 EGG HARBOR ROAD
Practice Address - Street 2:STE B2
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2359
Practice Address - Country:US
Practice Address - Phone:856-845-8300
Practice Address - Fax:856-845-2512
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07893400207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0081191Medicaid
NJ2384704OtherUNITED HEALTHCARE
NJ725612OtherWELLCARE
NJ8620841OtherAETNA HMO
NJ3174149OtherEMBLEM HEALTH GHI
NJ317940OtherU.S. FAMILY HEALTH
NJ4269570OtherCIGNA
NJ60135130OtherHORIZON N.J. FAMILYCARE
NJP3686827OtherOXFORD
NJ2458412000OtherAMERIHEALTH/KEYSTONE/IBC
NJP4622355OtherOXFORD
NJ010007467OtherAMERICHOICE
NJ1777834OtherAMERIHEALTH PPO/PA BS
NJ42286OtherUNIVERISTY HEALTH PLAN
NJ60019328OtherHORIZON NJ HEALTH
NJ3K5947OtherHEALTHNET
NJ7039561OtherAETNA
NJ60135130OtherHORIZON N.J. FAMILYCARE
NJ317940OtherU.S. FAMILY HEALTH
NJ094461N6ZMedicare PIN