Healthcare Provider Details

I. General information

NPI: 1922139989
Provider Name (Legal Business Name): NEAL GITTLEMAN, MD AND ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E KENNEDY BLVD
LAKEWOOD NJ
08701-1435
US

IV. Provider business mailing address

450 E KENNEDY BLVD
LAKEWOOD NJ
08701-1435
US

V. Phone/Fax

Practice location:
  • Phone: 732-901-0050
  • Fax: 732-370-2386
Mailing address:
  • Phone: 732-901-0050
  • Fax: 732-370-2386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA51323
License Number StateNJ

VIII. Authorized Official

Name: DR. NEAL DANA GITTLEMAN
Title or Position: OWNER
Credential: MD
Phone: 732-901-0050