Provider Demographics
NPI:1639331697
Name:JOHN J GARTLAND JR MD PC
Entity Type:Organization
Organization Name:JOHN J GARTLAND JR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GARTLAND
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:856-845-3443
Mailing Address - Street 1:636 KINGS HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEST DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-3164
Mailing Address - Country:US
Mailing Address - Phone:856-845-3443
Mailing Address - Fax:856-845-4544
Practice Address - Street 1:636 KINGS HWY
Practice Address - Street 2:SUITE B
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-3164
Practice Address - Country:US
Practice Address - Phone:856-845-3443
Practice Address - Fax:856-845-4544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA60918174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6610609Medicaid
NJF94277Medicare UPIN
NJ534361Medicare PIN