Healthcare Provider Details

I. General information

NPI: 1689746455
Provider Name (Legal Business Name): GARY E. STATMORE M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 VALLEY BLVD
WOOD RIDGE NJ
07075-1236
US

IV. Provider business mailing address

245 VALLEY BLVD
WOOD RIDGE NJ
07075-1236
US

V. Phone/Fax

Practice location:
  • Phone: 201-438-5500
  • Fax: 201-438-3363
Mailing address:
  • Phone: 201-438-5500
  • Fax: 201-438-3363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA02277200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA05862500
License Number StateNJ

VIII. Authorized Official

Name: GARY E STATMORE
Title or Position: OWNER
Credential: M.D.
Phone: 201-438-5500