Healthcare Provider Details

I. General information

NPI: 1932474954
Provider Name (Legal Business Name): JAIME N GILDENGERS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2012
Last Update Date: 03/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 60TH ST
WEST NEW YORK NJ
07093-5412
US

IV. Provider business mailing address

313 60TH ST
WEST NEW YORK NJ
07093-5412
US

V. Phone/Fax

Practice location:
  • Phone: 201-854-0406
  • Fax: 201-854-8437
Mailing address:
  • Phone: 201-854-0406
  • Fax: 201-854-8437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA02774200
License Number StateNJ

VIII. Authorized Official

Name: DR. JAIME N GILDENGERS
Title or Position: PRESIDENT
Credential: MD
Phone: 201-854-0406