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NPI Code Detail

MEDICARE: GOUT INSTITUTE OF AMERICA LLC

MEDICARE: GOUT INSTITUTE OF AMERICA LLC
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
1207LP2900XPain Medicine (Anesthesiology) Physician25MA08542000NJ

General Provider Information

NPI Number : 1598294019
Entity Type Code : Organization
Provider Name (Legal Business Name) : GOUT INSTITUTE OF AMERICA LLC
Provider Business Mailing Address
First Line : 727 JORALEMON ST
Second Line :
City : BELLEVILLE
State : NJ
Zip : 07109-1455
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 727 JORALEMON ST
Second Line :
City : BELLEVILLE
State : NJ
Zip : 07109-1455
Country : US
Telephone Number : 973-450-1600
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : DR. JORGE G MENDEZ
Credential : MD
Telephone Number : 908-255-6200
Provider Enumeration Date : 06/08/2017
Last Update Date : 06/08/2017

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Directions to “GOUT INSTITUTE OF AMERICA LLC ” Practice Location

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