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General NPI Number Information
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NPI Number | 1598294019
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Entity Type | Organization
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Legal Business Name | GOUT INSTITUTE OF AMERICA LLC
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Dates
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Enumeration Date | 06/08/2017
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Last Update Date | 06/08/2017
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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 | 07109-1455
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Country | US
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Telephone | 973-450-1600
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Fax |
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Provider Business Mailing 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 | 07109-1455
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. JORGE G MENDEZ
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Credential | MD
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Telephone | 908-255-6200
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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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