MEDICARE: KEVIN GAZZALE PA

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	363A00000X	Physician Assistant	25MP00835600	NJ

General Provider Information

NPI Number	:	1689439606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN GAZZALE PA

Provider Business Mailing Address
First Line	:	645 ROUTE 18
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-3760
Country	:	US
Telephone Number	:	908-705-3746
Fax Number	:

Provider Business Practice Location Address
First Line	:	645 ROUTE 18
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-3760
Country	:	US
Telephone Number	:	732-390-1160
Fax Number	:

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

Provider Enumeration Date	:	02/19/2024
Last Update Date	:	05/20/2024

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Directions to “ KEVIN GAZZALE PA” Practice Location

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