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General NPI Number Information
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NPI Number | 1982741328
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Entity Type | Individual
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Provider Name | ADAM C. GILLISS D.O.
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Gender | Male
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 27 E CHESTNUT AVE
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City | MERCHANTVILLE
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State | NJ
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Zip | 08109-2504
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Country | US
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Telephone | 856-662-0424
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Fax | 856-662-7404
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Provider Business Mailing Address
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Address Line | 27 E CHESTNUT AVE
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City | MERCHANTVILLE
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State | NJ
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Zip | 08109-2504
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Country | US
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Telephone | 856-662-0424
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Fax | 856-662-7404
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MB59981
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License Number State | NJ
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