Healthcare Provider Details

I. General information

NPI: 1942423538
Provider Name (Legal Business Name): GERALD E PFLUM MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 08/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 NEPTUNE BLVD UNIT 12
NEPTUNE NJ
07753-4121
US

IV. Provider business mailing address

444 NEPTUNE BLVD UNIT 12
NEPTUNE NJ
07753-4121
US

V. Phone/Fax

Practice location:
  • Phone: 732-775-1301
  • Fax: 732-775-0507
Mailing address:
  • Phone: 732-775-1301
  • Fax: 732-775-0507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number25MA032941
License Number StateNJ

VIII. Authorized Official

Name: MRS. EVELYN A PFLUM
Title or Position: CORPORATION SECRETARY
Credential: RN
Phone: 732-775-1301