Provider Demographics
NPI:1316984180
Name:HECK, GARY X (DO)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:X
Last Name:HECK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 GIBBSBORO RD
Mailing Address - Street 2:
Mailing Address - City:CLEMENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-4132
Mailing Address - Country:US
Mailing Address - Phone:856-784-4999
Mailing Address - Fax:856-784-0258
Practice Address - Street 1:222 GIBBSBORO RD
Practice Address - Street 2:
Practice Address - City:CLEMENTON
Practice Address - State:NJ
Practice Address - Zip Code:08021-4132
Practice Address - Country:US
Practice Address - Phone:856-784-4999
Practice Address - Fax:856-784-0258
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB34990207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0069608000OtherHMO INDEPEN BLUE CROSS
NJ2434601Medicaid
NJ000000331OtherPPO INDEPEN BLUE CROSS
NJ2434601Medicaid
NJE06012Medicare UPIN