Healthcare Provider Details

I. General information

NPI: 1578666707
Provider Name (Legal Business Name): FAINA M GUTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 EGG HARBOR ROAD STE B2
SEWELL NJ
08080-2359
US

IV. Provider business mailing address

630 SALEM AVE
WOODBURY NJ
08096
US

V. Phone/Fax

Practice location:
  • Phone: 856-845-8300
  • Fax: 856-845-2512
Mailing address:
  • Phone: 856-845-8300
  • Fax: 856-845-2512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number25MA07893400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: