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General NPI Number Information
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NPI Number | 1023380037
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Entity Type | Organization
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Legal Business Name | GATEWAY TO HEALTH
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Dates
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Enumeration Date | 02/07/2012
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Last Update Date | 10/16/2015
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Provider Practice Location Address
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Address Line | 30 HADLEY AVE
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City | CLIFTON
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State | NJ
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Zip | 07011
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Country | US
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Telephone | 973-330-5899
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Fax | 973-416-9861
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Provider Business Mailing Address
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Address Line | 1360 CLIFTON AVE SUITE 102
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City | CLIFTON
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State | NJ
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Zip | 07012-1453
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Country | US
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Telephone | 973-330-5899
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Fax | 973-416-9861
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Authorized Official
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Title or Position | CEO
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Name | MR. KEVIN D. GRABKOWSKI
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Credential | RRT RPSGT
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Telephone | 973-330-5899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 43ZA00309400
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License Number State | NJ
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