Healthcare Provider Details

I. General information

NPI: 1255699542
Provider Name (Legal Business Name): SHARMEZ GRESSHEL SAVOY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 ROUTE 22 STE 14
BRIDGEWATER NJ
08807-2943
US

IV. Provider business mailing address

37 MULBERRY CIR
STATEN ISLAND NY
10314-3715
US

V. Phone/Fax

Practice location:
  • Phone: 973-376-6595
  • Fax:
Mailing address:
  • Phone: 951-722-2365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA22064
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25MP00603900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number016892-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: