Healthcare Provider Details

I. General information

NPI: 1730143231
Provider Name (Legal Business Name): GREGORY J. SHYPULA, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 12/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 SAINT GEORGES AVE SUITE 307
AVENEL NJ
07001-1390
US

IV. Provider business mailing address

1030 SAINT GEORGES AVE SUITE 307
AVENEL NJ
07001-1390
US

V. Phone/Fax

Practice location:
  • Phone: 732-750-1200
  • Fax: 732-602-4044
Mailing address:
  • Phone: 732-750-1200
  • Fax: 732-602-4044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GREGORY J. SHYPULA
Title or Position: PHYSICIAN
Credential: MD
Phone: 732-750-1200