Provider Demographics
NPI:1699761924
Name:GILDENGERS, JAIME N (MD FACS)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:N
Last Name:GILDENGERS
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 60TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-5412
Mailing Address - Country:US
Mailing Address - Phone:201-854-0406
Mailing Address - Fax:201-854-8437
Practice Address - Street 1:313 60TH ST
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-5412
Practice Address - Country:US
Practice Address - Phone:201-854-0406
Practice Address - Fax:201-854-8437
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02774200208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2932407Medicaid
NJ2932407Medicaid
E40331Medicare UPIN