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NPI Code Detail

MEDICARE: VIRGINIA E GORMAN APN

MEDICARE: VIRGINIA E GORMAN APN
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
1363LA2200XAdult Health Nurse Practitioner26NN03637300NJ

General Provider Information

NPI Number : 1689823114
Entity Type Code : Individual
Provider Name (Legal Business Name) : VIRGINIA E GORMAN APN
Provider Business Mailing Address
First Line : 1 BEACH AVE
Second Line :
City : LONG BRANCH
State : NJ
Zip : 07740-7905
Country : US
Telephone Number : 732-870-3460
Fax Number :
Provider Business Practice Location Address
First Line : 62 E MAIN ST
Second Line :
City : SOMERVILLE
State : NJ
Zip : 08876-2312
Country : US
Telephone Number : 908-725-8880
Fax Number : 908-725-5656
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2008
Last Update Date : 09/09/2008

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Directions to “ VIRGINIA E GORMAN APN” Practice Location

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