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NPI Code Detail

MEDICARE: DR. MICHAEL ANDREW GISTRAK MD

MEDICARE:  DR. MICHAEL ANDREW GISTRAK  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ZP0101XAnatomic Pathology Physician25MA06367700NJ
2207ZP0102XAnatomic Pathology & Clinical Pathology Physician25MA06367700NJ
3174400000XSpecialist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396793972
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL ANDREW GISTRAK MD
Provider Business Mailing Address
First Line : 865 STONE ST
Second Line :
City : RAHWAY
State : NJ
Zip : 07065-2742
Country : US
Telephone Number : 732-499-6139
Fax Number : 732-499-6122
Provider Business Practice Location Address
First Line : 865 STONE ST
Second Line :
City : RAHWAY
State : NJ
Zip : 07065-2742
Country : US
Telephone Number : 732-499-6139
Fax Number : 732-499-6122
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2006
Last Update Date : 11/22/2017

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Directions to “ DR. MICHAEL ANDREW GISTRAK MD” Practice Location

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