Provider Demographics
NPI:1760375414
Name:LOGAN, GERALD (RN)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:
Last Name:LOGAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 LAWRENCE LN
Mailing Address - Street 2:
Mailing Address - City:DELRAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-1356
Mailing Address - Country:US
Mailing Address - Phone:856-729-5266
Mailing Address - Fax:
Practice Address - Street 1:311 WALTON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-9579
Practice Address - Country:US
Practice Address - Phone:800-774-5516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR26795800163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse