Provider Demographics
NPI:1770523938
Name:LENGEL, GARY P (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:P
Last Name:LENGEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1100 ROUTE 72 W
Mailing Address - Street 2:SUITE 307
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2468
Mailing Address - Country:US
Mailing Address - Phone:609-625-8000
Mailing Address - Fax:609-978-8941
Practice Address - Street 1:1100 ROUTE 72 W
Practice Address - Street 2:SUITE 307
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2468
Practice Address - Country:US
Practice Address - Phone:609-625-8000
Practice Address - Fax:609-978-8941
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2014-02-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA063938002086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7050500Medicaid
NJP00297590OtherRR MEDICARE
NJ888933Medicare PIN
NJP00297590OtherRR MEDICARE
NJ7050500Medicaid