Healthcare Provider Details

I. General information

NPI: 1831169515
Provider Name (Legal Business Name): JOHN D GUMINA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 05/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3499 ROUTE 9 N
FREEHOLD NJ
07728-3258
US

IV. Provider business mailing address

3499 ROUTE 9 N
FREEHOLD NJ
07728-3258
US

V. Phone/Fax

Practice location:
  • Phone: 732-625-3166
  • Fax: 732-409-7473
Mailing address:
  • Phone: 732-625-3166
  • Fax: 732-409-7473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMA30356
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: