Provider Demographics
NPI:1952541302
Name:GARY J GAWLER MD PA
Entity Type:Organization
Organization Name:GARY J GAWLER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GAWLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-291-0265
Mailing Address - Street 1:100 OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC HIGHLANDS
Mailing Address - State:NJ
Mailing Address - Zip Code:07716-1532
Mailing Address - Country:US
Mailing Address - Phone:732-291-0265
Mailing Address - Fax:732-291-0704
Practice Address - Street 1:100 OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:ATLANTIC HIGHLANDS
Practice Address - State:NJ
Practice Address - Zip Code:07716-1532
Practice Address - Country:US
Practice Address - Phone:732-291-0265
Practice Address - Fax:732-291-0704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03799800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3030300-1Medicaid