Provider Demographics
NPI:1942380258
Name:GERARDO V. ESTEVEZ. MD PA
Entity Type:Organization
Organization Name:GERARDO V. ESTEVEZ. MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:VILLARUZ
Authorized Official - Last Name:ESTEVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-452-0680
Mailing Address - Street 1:1931 OAK TREE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2072
Mailing Address - Country:US
Mailing Address - Phone:732-452-0680
Mailing Address - Fax:732-452-9136
Practice Address - Street 1:1931 OAK TREE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2072
Practice Address - Country:US
Practice Address - Phone:732-452-0680
Practice Address - Fax:732-452-9136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA059688207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF85771Medicare UPIN