Provider Demographics
NPI:1801957626
Name:HUIE, GORDON (PA)
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:
Last Name:HUIE
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:360 ESSEX ST STE 303
Mailing Address - Street 2:HACKENSACK UNIVERSITY MEDICAL CENTER
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-8566
Mailing Address - Country:US
Mailing Address - Phone:201-336-8831
Mailing Address - Fax:201-336-8908
Practice Address - Street 1:360 ESSEX ST STE 303
Practice Address - Street 2:HACKENSACK UNIVERSITY MEDICAL CENTER
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-8566
Practice Address - Country:US
Practice Address - Phone:201-336-8831
Practice Address - Fax:201-336-8908
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00046500363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P26826Medicare UPIN