Provider Demographics
NPI:1639479397
Name:EDDIE M GAMAO, MD PA
Entity Type:Organization
Organization Name:EDDIE M GAMAO, MD PA
Other - Org Name:EDDIE M GAMAO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GAMAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-981-9336
Mailing Address - Street 1:1032 STELTON RD
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-4316
Mailing Address - Country:US
Mailing Address - Phone:732-981-9336
Mailing Address - Fax:732-981-9339
Practice Address - Street 1:1032 STELTON RD
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-4316
Practice Address - Country:US
Practice Address - Phone:732-981-9336
Practice Address - Fax:732-981-9339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA27432207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2833603Medicaid
NJ459352Medicare PIN
NJ2833603Medicaid