Provider Demographics
NPI:1528248978
Name:GOTTLIEB, YVONNE MARCELLA (CRNA/APN ANESTHESIA)
Entity type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:MARCELLA
Last Name:GOTTLIEB
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Gender:F
Credentials:CRNA/APN ANESTHESIA
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Mailing Address - Street 1:22 DUMAS RD
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-1679
Mailing Address - Country:US
Mailing Address - Phone:732-679-7329
Mailing Address - Fax:732-679-2531
Practice Address - Street 1:561 CRANBURY RD
Practice Address - Street 2:UNIVERSITY SURGERY CENTER/METROANESTHESIA CONSULTANTS
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5400
Practice Address - Country:US
Practice Address - Phone:732-390-4300
Practice Address - Fax:732-390-0556
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2010-10-26
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Provider Licenses
StateLicense IDTaxonomies
NJ26NR07692800367500000X
NJ26NJ00202900363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ759200SJWMedicare PIN