Provider Demographics
NPI:1699580035
Name:GOSSELIN, MARY ANN
Entity type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:
Last Name:GOSSELIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 NEW DOVER RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1999
Mailing Address - Country:US
Mailing Address - Phone:732-381-5858
Mailing Address - Fax:
Practice Address - Street 1:660 NEW DOVER RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1999
Practice Address - Country:US
Practice Address - Phone:732-381-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJJP00338600176P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176P00000XOther Service ProvidersFuneral Director