Provider Demographics
NPI:1205983251
Name:MICHAEL C GARTNER DO PC
Entity type:Organization
Organization Name:MICHAEL C GARTNER DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:GARTNER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-265-1300
Mailing Address - Street 1:3 WINSLOW PL
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2709
Mailing Address - Country:US
Mailing Address - Phone:201-546-1890
Mailing Address - Fax:201-546-1893
Practice Address - Street 1:3 WINSLOW PL
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2709
Practice Address - Country:US
Practice Address - Phone:201-546-1890
Practice Address - Fax:201-546-1893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06848500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2800738000OtherAMERIHEALTH GROUP #
NJ2800738000OtherAMERIHEALTH GROUP #