Provider Demographics
NPI:1285255539
Name:GEMSTONE PEDIATRICS
Entity type:Organization
Organization Name:GEMSTONE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:GARNETT
Authorized Official - Last Name:CARRUTH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:973-752-5272
Mailing Address - Street 1:25 SALTER PL
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2629
Mailing Address - Country:US
Mailing Address - Phone:973-752-5272
Mailing Address - Fax:
Practice Address - Street 1:485 PARK AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-1721
Practice Address - Country:US
Practice Address - Phone:973-672-2770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA07029000OtherMEDICAL LICENSE