Provider Demographics
NPI:1730143231
Name:GREGORY J. SHYPULA, MD, PA
Entity Type:Organization
Organization Name:GREGORY J. SHYPULA, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHYPULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-750-1200
Mailing Address - Street 1:1030 SAINT GEORGES AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:AVENEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07001-1390
Mailing Address - Country:US
Mailing Address - Phone:732-750-1200
Mailing Address - Fax:732-602-4044
Practice Address - Street 1:1030 SAINT GEORGES AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:AVENEL
Practice Address - State:NJ
Practice Address - Zip Code:07001-1390
Practice Address - Country:US
Practice Address - Phone:732-750-1200
Practice Address - Fax:732-602-4044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherPRIVATE INSURERS
NJ072892Medicare ID - Type Unspecified
NJ5120900001Medicare NSC