Provider Demographics
NPI:1427086040
Name:LOREN, GARY (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:LOREN
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 1:1666 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08629-1476
Mailing Address - Country:US
Mailing Address - Phone:609-584-9080
Mailing Address - Fax:609-584-0139
Practice Address - Street 1:1666 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08629-1432
Practice Address - Country:US
Practice Address - Phone:609-584-9080
Practice Address - Fax:609-584-0139
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05140500207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ840408Medicaid
NJ541457Medicare ID - Type Unspecified
NJC54301Medicare UPIN