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General NPI Number Information
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NPI Number | 1457842429
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Entity Type | Organization
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Legal Business Name | GOUT INSTITUTE OF AMERICA
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Dates
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Enumeration Date | 05/24/2018
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Last Update Date | 05/24/2018
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Provider Practice Location Address
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Address Line | 727 JORALEMON ST.
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City | BELLEVILLE
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State | NJ
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Zip | 07109
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Country | US
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Telephone | 973-450-1600
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Fax | 973-450-1600
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Provider Business Mailing Address
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Address Line | 727 JORALEMON STREET
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City | BELLEVILLE
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State | NJ
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Zip | 07109
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Country | US
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Telephone | 973-450-1600
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Fax | 973-450-1602
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Authorized Official
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Title or Position | OWNER
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Name | DR. JORGE G. MENDEZ
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Credential | M.D.
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Telephone | 973-450-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 25MA08542000
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License Number State | NJ
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