Provider Demographics
NPI:1841487196
Name:GORDONS CORNER MEDICAL GROUP,PC
Entity type:Organization
Organization Name:GORDONS CORNER MEDICAL GROUP,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:ZBIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-972-2264
Mailing Address - Street 1:225 GORDONS CORNER RD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3342
Mailing Address - Country:US
Mailing Address - Phone:732-972-2264
Mailing Address - Fax:732-446-5723
Practice Address - Street 1:225 GORDONS CORNER RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3342
Practice Address - Country:US
Practice Address - Phone:732-972-2264
Practice Address - Fax:732-446-5723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1184727638OtherINDIVIDUAL NPI
NJ1184727638OtherINDIVIDUAL NPI
NJ503954Medicare PIN