Provider Demographics
NPI:1255379772
Name:GITTLEMAN, NEAL DANA (MD)
Entity type:Individual
Prefix:DR
First Name:NEAL
Middle Name:DANA
Last Name:GITTLEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 E KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-1435
Mailing Address - Country:US
Mailing Address - Phone:732-901-0050
Mailing Address - Fax:732-370-2386
Practice Address - Street 1:450 E KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-1435
Practice Address - Country:US
Practice Address - Phone:732-901-0050
Practice Address - Fax:732-370-2386
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA51323208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics