Provider Demographics
NPI:1306466289
Name:GERLING INSTITUTE NJ PC
Entity type:Organization
Organization Name:GERLING INSTITUTE NJ PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-584-8903
Mailing Address - Street 1:1117 US HIGHWAY 46 STE 201
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2450
Mailing Address - Country:US
Mailing Address - Phone:212-882-1110
Mailing Address - Fax:212-882-1120
Practice Address - Street 1:1117 US HIGHWAY 46 STE 201
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2450
Practice Address - Country:US
Practice Address - Phone:212-882-1110
Practice Address - Fax:212-882-1120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1376647891OtherINDIVIDUAL NPI NUMBER
NJ25MA08958600OtherSTATE LICENSE NUMBER