Provider Demographics
NPI:1699749556
Name:DRS. GOULD, HENDERSON, ROGERS, AND VACLAVIK LLC
Entity type:Organization
Organization Name:DRS. GOULD, HENDERSON, ROGERS, AND VACLAVIK LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-695-2040
Mailing Address - Street 1:804 W PARK AVE
Mailing Address - Street 2:BUILDING A
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-7272
Mailing Address - Country:US
Mailing Address - Phone:732-695-2040
Mailing Address - Fax:732-695-1768
Practice Address - Street 1:804 W PARK AVE
Practice Address - Street 2:BUILDING A
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-7272
Practice Address - Country:US
Practice Address - Phone:732-695-2040
Practice Address - Fax:732-695-1768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7968701Medicaid
NJ7968701Medicaid