Provider Demographics
NPI:1821278433
Name:EWING, GREGORY G (PA)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:G
Last Name:EWING
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:695 US HIGHWAY 46
Mailing Address - Street 2:STE 400A
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-1568
Mailing Address - Country:US
Mailing Address - Phone:973-826-8291
Mailing Address - Fax:888-972-6480
Practice Address - Street 1:611 COURTYARD DR
Practice Address - Street 2:BUILDING 600
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-4256
Practice Address - Country:US
Practice Address - Phone:908-722-0030
Practice Address - Fax:908-722-0188
Is Sole Proprietor?:No
Enumeration Date:2007-11-12
Last Update Date:2018-09-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00029600363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ527111OtherMEDICARE RAILROAD
NJ527111OtherMEDICARE RAILROAD
NJSF2179Medicare PIN