Healthcare Provider Details

I. General information

NPI: 1649259045
Provider Name (Legal Business Name): NEIL GAFFIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 12/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

947 LINWOOD AVE SUITE 2E
RIDGEWOOD NJ
07450-2939
US

IV. Provider business mailing address

947 LINWOOD AVE SUITE 2E
RIDGEWOOD NJ
07450-2939
US

V. Phone/Fax

Practice location:
  • Phone: 201-447-6468
  • Fax: 201-447-3189
Mailing address:
  • Phone: 201-447-6468
  • Fax: 201-447-3189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMA71002
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: