MEDICARE: DR. GARY J NOEL MD

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	208000000X	Pediatrics Physician	25MA04718100	NJ
2	2080P0208X	Pediatric Infectious Diseases Physician	25MA04718100	NJ

General Provider Information

NPI Number	:	1841456282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY J NOEL MD

Provider Business Mailing Address
First Line	:	16 HIGHLAND DR
Second Line	:
City	:	NORTH CALDWELL
State	:	NJ
Zip	:	07006-4029
Country	:	US
Telephone Number	:	973-364-7627
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 HIGHLAND DR
Second Line	:
City	:	NORTH CALDWELL
State	:	NJ
Zip	:	07006-4029
Country	:	US
Telephone Number	:	973-364-7627
Fax Number	:

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

Provider Enumeration Date	:	08/05/2008
Last Update Date	:	08/05/2008

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