Healthcare Provider Details

I. General information

NPI: 1386615425
Provider Name (Legal Business Name): GREGORY C OLIVER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 PARK AVE SUITE 101
EDISON NJ
08820-3032
US

IV. Provider business mailing address

3900 PARK AVE SUITE 101
EDISON NJ
08820-3032
US

V. Phone/Fax

Practice location:
  • Phone: 732-494-6640
  • Fax: 732-549-8204
Mailing address:
  • Phone: 732-494-6640
  • Fax: 732-549-8204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number25MA04291500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: