MEDICARE: MICHAEL A. GERSTMANN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MA07577400	NJ

General Provider Information

NPI Number	:	1073510947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL A. GERSTMANN M.D.

Provider Business Mailing Address
First Line	:	183 S ORANGE AVE
Second Line	:	BHSB B-1455
City	:	NEWARK
State	:	NJ
Zip	:	07103-2757
Country	:	US
Telephone Number	:	973-972-6479
Fax Number	:	973-972-8626

Provider Business Practice Location Address
First Line	:	183 S ORANGE AVE
Second Line	:	BHSB B-1455
City	:	NEWARK
State	:	NJ
Zip	:	07103-2757
Country	:	US
Telephone Number	:	973-972-6479
Fax Number	:	973-972-8626

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	02/08/2022

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