Healthcare Provider Details

I. General information

NPI: 1861496572
Provider Name (Legal Business Name): GREGORY HEYT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 BROAD ST
RED BANK NJ
07701-2150
US

IV. Provider business mailing address

365 BROAD ST
RED BANK NJ
07701-2150
US

V. Phone/Fax

Practice location:
  • Phone: 732-842-4294
  • Fax: 732-842-3854
Mailing address:
  • Phone: 732-842-4294
  • Fax: 732-842-3854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMA072947
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: