Healthcare Provider Details

I. General information

NPI: 1922107754
Provider Name (Legal Business Name): GORCEY UPPAL PTRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1912 ROUTE 35 STE 201
OAKHURST NJ
07755-2768
US

IV. Provider business mailing address

142 STATE ROUTE 35 S
EATONTOWN NJ
07724-1876
US

V. Phone/Fax

Practice location:
  • Phone: 908-692-3154
  • Fax:
Mailing address:
  • Phone: 732-389-5004
  • Fax: 732-389-1850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHARRON FLETCHER
Title or Position: MANAGER
Credential:
Phone: 908-692-3154