Healthcare Provider Details

I. General information

NPI: 1043411804
Provider Name (Legal Business Name): GARY UDASIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 GALLOPING HILL ROAD EMPLOYEE HEALTH SERVICES
KENILWORTH NJ
08816
US

IV. Provider business mailing address

2000 GALLOPING HILL ROAD EMPLOYEE HEALTH SERVICES
KENILWORTH NJ
08816
US

V. Phone/Fax

Practice location:
  • Phone: 908-298-2830
  • Fax: 908-298-2834
Mailing address:
  • Phone: 908-298-2830
  • Fax: 908-298-2834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberMA042844
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: