Provider Demographics
NPI:1831754670
Name:GUTKIND, ERIN MICHELLE
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:MICHELLE
Last Name:GUTKIND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 FAWNRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LONG VALLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07853-3249
Mailing Address - Country:US
Mailing Address - Phone:973-525-9112
Mailing Address - Fax:
Practice Address - Street 1:535 SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4224
Practice Address - Country:US
Practice Address - Phone:732-741-0970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00528600363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant