Basic Information
| Provider Information | |||||||||
| NPI: | 1003834102 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOSSE | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | RADIATION ONCOLOGY-SOMC | ||||||||
| Address2: | 1140 ROUTE 72 WEST | ||||||||
| City: | MANAHAWKIN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080501026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6099782194 | ||||||||
| FaxNumber: | 6099782843 | ||||||||
| Practice Location | |||||||||
| Address1: | RADIATION ONCOLOGY-SOMC | ||||||||
| Address2: | 1140 ROUTE 72 WEST | ||||||||
| City: | MANAHAWKIN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080500805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6099782194 | ||||||||
| FaxNumber: | 6099782843 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 12/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 009647 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 4144417 | 01 | NY | MVP | OTHER | 000405485002 | 01 | NY | BLUE SHIELD | OTHER |