Healthcare Provider Details

I. General information

NPI: 1073996609
Provider Name (Legal Business Name): PRIYANKA GUMASTE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2015
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 HUDSON PL
HOBOKEN NJ
07030-5594
US

IV. Provider business mailing address

2 HUDSON PL
HOBOKEN NJ
07030-5594
US

V. Phone/Fax

Practice location:
  • Phone: 201-795-0021
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number25MA10604000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: