Provider Demographics
NPI:1699872218
Name:GERSTEN, MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:GERSTEN
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 1:3 VANDERVEER DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-3113
Mailing Address - Country:US
Mailing Address - Phone:609-896-4263
Mailing Address - Fax:609-588-0159
Practice Address - Street 1:3 VANDERVEER DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-3113
Practice Address - Country:US
Practice Address - Phone:609-588-0888
Practice Address - Fax:609-588-0159
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA43797207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1053906Medicaid
NJ1053906Medicaid
NJD06044Medicare UPIN