Provider Demographics
NPI:1396724324
Name:GUTMAN, WILLIAM M (DPM)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:GUTMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:750 S WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-2000
Mailing Address - Country:US
Mailing Address - Phone:609-567-0606
Mailing Address - Fax:609-567-2509
Practice Address - Street 1:408 CHRIS GAUPP DR STE 300
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4489
Practice Address - Country:US
Practice Address - Phone:609-404-0700
Practice Address - Fax:609-404-0712
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00100700213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0736309Medicaid
NJ7820240001OtherDMERC
NJ1396724324OtherINDIVIDUAL NPI