Provider Demographics
NPI:1801943220
Name:GERBER, AUSTIN JAMES (DO)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:JAMES
Last Name:GERBER
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 1:850 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-1438
Mailing Address - Country:US
Mailing Address - Phone:609-641-1118
Mailing Address - Fax:609-383-9370
Practice Address - Street 1:850 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-1438
Practice Address - Country:US
Practice Address - Phone:609-641-1118
Practice Address - Fax:609-383-9370
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB36146207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1387804Medicaid
0419368001OtherAMERIHEALTH
0419368001OtherAMERIHEALTH