Provider Demographics
NPI:1992758007
Name:GANON, MICHAEL R (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:GANON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:179 HIGH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-1010
Mailing Address - Country:US
Mailing Address - Phone:973-862-4297
Mailing Address - Fax:973-327-7760
Practice Address - Street 1:179 HIGH ST STE 101
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-1010
Practice Address - Country:US
Practice Address - Phone:973-862-4297
Practice Address - Fax:973-327-7760
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMB57839207P00000X
NJ25MB05783900207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine