Healthcare Provider Details

I. General information

NPI: 1023448214
Provider Name (Legal Business Name): GATEWAY EMERGENCY SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2013
Last Update Date: 05/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CENTRAL AVE EMERGENCY DEPARTMENT
NEWARK NJ
07102-1909
US

IV. Provider business mailing address

3114 CROASDAILE DR SUITE 200
DURHAM NC
27705-2508
US

V. Phone/Fax

Practice location:
  • Phone: 469-401-2386
  • Fax: 919-425-0478
Mailing address:
  • Phone: 469-401-2386
  • Fax: 919-425-0478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TENNA BEHM
Title or Position: VICE PRESIDENT
Credential:
Phone: 469-401-2386