MEDICARE: DR. TED GUTOWSKI M.D.

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
1	207R00000X	Internal Medicine Physician	25MA05292700	NJ
2	207RC0000X	Cardiovascular Disease Physician	25MA05292700	NJ
3	207RI0011X	Interventional Cardiology Physician	MA52927	NJ
4	207RC0000X	Cardiovascular Disease Physician	MA52927	NJ

Other Identifiers

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

General Provider Information

NPI Number	:	1669476073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TED GUTOWSKI M.D.

Provider Business Mailing Address
First Line	:	901 W MAIN ST
Second Line	:	SUITE 205
City	:	FREEHOLD
State	:	NJ
Zip	:	07728-2537
Country	:	US
Telephone Number	:	732-866-0800
Fax Number	:	732-463-6082

Provider Business Practice Location Address
First Line	:	901 W MAIN ST
Second Line	:	SUITE 205
City	:	FREEHOLD
State	:	NJ
Zip	:	07728-2537
Country	:	US
Telephone Number	:	732-866-0800
Fax Number	:	732-463-6082

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	04/12/2024

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Directions to “ DR. TED GUTOWSKI M.D.” Practice Location

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