Provider Demographics
NPI:1780619171
Name:GARTNER, MICHAEL CONSTANTIN (DO)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CONSTANTIN
Last Name:GARTNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WINSLOW PLACE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652
Mailing Address - Country:US
Mailing Address - Phone:201-546-1890
Mailing Address - Fax:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06848500208200000X
NY2137701208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H67751Medicare UPIN
NJ060344M4LMedicare ID - Type Unspecified