Healthcare Provider Details

I. General information

NPI: 1093750929
Provider Name (Legal Business Name): KATHLEEN M. GEKOWSKI MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 PARKSIDE AVENUE SUITE #4
EWING NJ
08638
US

IV. Provider business mailing address

1450 PARKSIDE AVENUE SUITE #4
EWING NJ
08638
US

V. Phone/Fax

Practice location:
  • Phone: 609-882-3500
  • Fax: 609-882-3501
Mailing address:
  • Phone: 609-882-3500
  • Fax: 609-882-3501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMA040640
License Number StateNJ

VIII. Authorized Official

Name: LYNN C BITTINGER
Title or Position: MANAGER
Credential:
Phone: 609-882-3500