Healthcare Provider Details

I. General information

NPI: 1174613178
Provider Name (Legal Business Name): ELVIRA J GUTIERREZ PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 W SAINT GEORGES AVE
LINDEN NJ
07036-5638
US

IV. Provider business mailing address

110 BENDER AVE
ROSELLE PARK NJ
07204-2402
US

V. Phone/Fax

Practice location:
  • Phone: 908-925-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00139500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: