Provider Demographics
NPI:1316065378
Name:MICHAEL GUTKIN MD LLC
Entity type:Organization
Organization Name:MICHAEL GUTKIN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-597-1107
Mailing Address - Street 1:349 E NORTHFIELD RD STE 202
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4806
Mailing Address - Country:US
Mailing Address - Phone:973-597-1107
Mailing Address - Fax:973-597-1407
Practice Address - Street 1:349 E NORTHFIELD RD STE 202
Practice Address - Street 2:SUITE 202
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4806
Practice Address - Country:US
Practice Address - Phone:973-597-1107
Practice Address - Fax:973-597-1407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06846000207R00000X
NJ25MA02035200207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ096155Medicare ID - Type UnspecifiedMEDICARE GROUP ID