Provider Demographics
NPI:1720064215
Name:MACHADO, GERARD A (PSYD, APN-BC)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:A
Last Name:MACHADO
Suffix:
Gender:M
Credentials:PSYD, APN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 ROSEBERRY ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1600
Mailing Address - Country:US
Mailing Address - Phone:908-454-7244
Mailing Address - Fax:908-859-2109
Practice Address - Street 1:305 ROSEBERRY ST
Practice Address - Street 2:SUITE 8
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1600
Practice Address - Country:US
Practice Address - Phone:908-454-7244
Practice Address - Fax:908-859-2109
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00040600363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ076429OtherNURSE PRACTITIONER