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General NPI Number Information
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NPI Number | 1285255539
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Entity Type | Organization
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Legal Business Name | GEMSTONE PEDIATRICS
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Dates
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Enumeration Date | 04/28/2020
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 485 PARK AVE
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City | ORANGE
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State | NJ
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Zip | 07050-1721
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Country | US
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Telephone | 973-672-2770
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Fax |
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Provider Business Mailing Address
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Address Line | 25 SALTER PL
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City | MAPLEWOOD
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State | NJ
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Zip | 07040-2629
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Country | US
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Telephone | 973-752-5272
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Fax |
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Authorized Official
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Title or Position | PEDIATRICIAN
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Name | SAMUEL GARNETT CARRUTH JR.
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Credential | MD
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Telephone | 973-752-5272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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