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General NPI Number Information
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NPI Number | 1588631048
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Entity Type | Individual
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Provider Name | GARY E STATMORE M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/03/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 245 VALLEY BLVD
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City | WOOD-RIDGE
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State | NJ
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Zip | 07075-1236
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Country | US
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Telephone | 201-438-5500
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Fax | 201-438-3363
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Provider Business Mailing Address
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Address Line | 245 VALLEY BLVD
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City | WOOD-RIDGE
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State | NJ
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Zip | 07075-1236
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Country | US
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Telephone | 201-438-5500
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Fax | 201-438-3363
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 25MA02277200
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License Number State | NJ
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