Provider Demographics
NPI:1588631048
Name:STATMORE, GARY E (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:E
Last Name:STATMORE
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 1:245 VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:WOOD-RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07075-1236
Mailing Address - Country:US
Mailing Address - Phone:201-438-5500
Mailing Address - Fax:201-438-3363
Practice Address - Street 1:245 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:WOOD-RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07075-1236
Practice Address - Country:US
Practice Address - Phone:201-438-5500
Practice Address - Fax:201-438-3363
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02277200207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ529713OtherAETNA HMO
NJBP481OtherOXFORD
NJ1458108Medicaid
NJ5356729010OtherCIGNA HMO PCP
NJ5356729014OtherCIGNA HMO SPECIALIST
NJ486391OtherAETNA PPO
NJ0K3970OtherHEALTHNET
NJ0081399000OtherAMERIHEALTH
NJ5356729010OtherCIGNA HMO PCP
NJ1458108Medicaid