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General NPI Number Information
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NPI Number | 1063472017
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Entity Type | Individual
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Provider Name | CARL K GJERTSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 263 FARMINGTON AVE UROLOGY
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City | FARMINGTON
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State | CT
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Zip | 06030-6227
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Country | US
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Telephone | 860-679-4100
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Fax | 860-679-1390
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Provider Business Mailing Address
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Address Line | 331 NEWMAN SPRINGS ROAD BLDG. 2, SUITE 220
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City | RED BANK
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State | NJ
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Zip | 07701
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Country | US
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Telephone | 732-807-0877
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Fax | 201-751-1680
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2088P0231X
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Taxonomy Name | Pediatric Urology Physician
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License Number | 045171
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 045171
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 25MA12258300
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License Number State | NJ
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