Provider Demographics
NPI:1942358288
Name:URS, GWEN A (DMSC, MS, PA-C)
Entity Type:Individual
Prefix:
First Name:GWEN
Middle Name:A
Last Name:URS
Suffix:
Gender:F
Credentials:DMSC, MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 PROFESSIONAL VIEW DR
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-7904
Mailing Address - Country:US
Mailing Address - Phone:732-720-2555
Mailing Address - Fax:732-720-2556
Practice Address - Street 1:301 PROFESSIONAL VIEW DR BLDG 300
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-7904
Practice Address - Country:US
Practice Address - Phone:732-720-2555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00110300363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q29801Medicare UPIN
NJ085959BBFMedicare ID - Type Unspecified