=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215173281
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CINDY LEE GASKINS APN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2008
-----------------------------------------------------
Last Update Date | 07/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 776 MOUNTAIN BLVD SUITE 106
-----------------------------------------------------
City | WATCHUNG
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07069-6269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-361-0353
-----------------------------------------------------
Fax | 908-279-7689
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17 WICHSER LN
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07059-2618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-361-0353
-----------------------------------------------------
Fax | 908-279-7689
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 26NJ00169000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------