Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | MA020352 | NJ |
NPI | 1033152244 |
---|---|
Provider Name | Dr. Michael Gutkin |
First Address | Livingston, NJ 07039-4802 |
Second Address | Livingston, NJ 07039-4802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 08/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C58532 | (02) | NJ |