Provider Demographics
NPI:1760465579
Name:GONTER, NEIL (MD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:
Last Name:GONTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1415 QUEEN ANNE RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3521
Mailing Address - Country:US
Mailing Address - Phone:201-837-7788
Mailing Address - Fax:201-837-2077
Practice Address - Street 1:1415 QUEEN ANNE RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3521
Practice Address - Country:US
Practice Address - Phone:201-837-7788
Practice Address - Fax:201-837-2077
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ70545207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA07054500OtherNJ STATE LICENCE
NJ25MA07054500OtherNJ STATE LICENCE
NJ069488Medicare PIN