Healthcare Provider Details

I. General information

NPI: 1801253794
Provider Name (Legal Business Name): DR. BASIA ANDREJKO-GWOREK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2016
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 ROUTE 66 STE 331
TINTON FALLS NJ
07753-7300
US

IV. Provider business mailing address

4000 ROUTE 66 STE 331
TINTON FALLS NJ
07753-7300
US

V. Phone/Fax

Practice location:
  • Phone: 732-988-3441
  • Fax: 732-988-7123
Mailing address:
  • Phone: 732-988-3441
  • Fax: 732-988-7123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35SI00767400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: