Provider Demographics
NPI:1649218413
Name:MRUZ, GARY R (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:R
Last Name:MRUZ
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 1:1217 ROUTE 9
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OCEAN VIEW
Mailing Address - State:NJ
Mailing Address - Zip Code:08230-1379
Mailing Address - Country:US
Mailing Address - Phone:609-390-8772
Mailing Address - Fax:609-390-8699
Practice Address - Street 1:1217 ROUTE 9
Practice Address - Street 2:SUITE 101
Practice Address - City:OCEAN VIEW
Practice Address - State:NJ
Practice Address - Zip Code:08230-1379
Practice Address - Country:US
Practice Address - Phone:609-390-8772
Practice Address - Fax:609-390-8699
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC03565111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0162457000OtherAMERIHEALTH
NJ6482708Medicaid
NJMR470338Medicare ID - Type Unspecified