Provider Demographics
NPI:1629292990
Name:LOGATTO, GILBERT B (DC)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:B
Last Name:LOGATTO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1172 FISCHER BLVD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-3063
Mailing Address - Country:US
Mailing Address - Phone:732-506-0022
Mailing Address - Fax:631-422-3507
Practice Address - Street 1:1172 FISCHER BLVD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-3063
Practice Address - Country:US
Practice Address - Phone:732-506-0022
Practice Address - Fax:631-422-3507
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00025400171100000X
NJ38MC00354600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJL0651953Medicare ID - Type UnspecifiedMEDICARE