Provider Demographics
NPI:1700849759
Name:GLEASON, CATHERINE ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ELIZABETH
Last Name:GLEASON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 HWY 31 STE 1000
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-5755
Mailing Address - Country:US
Mailing Address - Phone:908-968-3162
Mailing Address - Fax:908-968-3181
Practice Address - Street 1:121 HWY 31 STE 1000
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-5755
Practice Address - Country:US
Practice Address - Phone:908-968-3162
Practice Address - Fax:908-968-3181
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07973700208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0094153Medicaid
NJ099153Medicare ID - Type Unspecified
D29568Medicare UPIN