Healthcare Provider Details

I. General information

NPI: 1114096765
Provider Name (Legal Business Name): GARY B NACKMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 US HIGHWAY 46 SUITE 202
CLIFTON NJ
07013-2451
US

IV. Provider business mailing address

1037 US HIGHWAY 46 SUITE 202
CLIFTON NJ
07013-2451
US

V. Phone/Fax

Practice location:
  • Phone: 973-778-2222
  • Fax: 973-860-1148
Mailing address:
  • Phone: 973-778-2222
  • Fax: 973-860-1148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMA64837
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: