Provider Demographics
NPI:1194799106
Name:GERTZMAN, JERROLD S (MD)
Entity type:Individual
Prefix:
First Name:JERROLD
Middle Name:S
Last Name:GERTZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4056 QUAKERBRIDGE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-4779
Mailing Address - Country:US
Mailing Address - Phone:609-528-9150
Mailing Address - Fax:609-528-9151
Practice Address - Street 1:4056 QUAKERBRIDGE ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-4779
Practice Address - Country:US
Practice Address - Phone:609-528-9150
Practice Address - Fax:609-528-9151
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06778000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8269009Medicaid
NJH14022Medicare UPIN
NJ8269009Medicaid