Healthcare Provider Details

I. General information

NPI: 1194630194
Provider Name (Legal Business Name): YI GU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 W JIMMIE LEEDS RD
POMONA NJ
08240-9102
US

IV. Provider business mailing address

331 POPLAR AVE
GALLOWAY NJ
08205-4592
US

V. Phone/Fax

Practice location:
  • Phone: 609-652-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number25ME00097101
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number26NJ15641700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: