Basic Information
| Provider Information | |||||||||
| NPI: | 1295883825 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GASKEL | ||||||||
| FirstName: | VIRGINIA | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 832 BRUNSWICK AVE | ||||||||
| Address2: | |||||||||
| City: | TRENTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086383829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098157815 | ||||||||
| FaxNumber: | 6098157814 | ||||||||
| Practice Location | |||||||||
| Address1: | 832 BRUNSWICK AVE | ||||||||
| Address2: | |||||||||
| City: | TRENTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086383829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098157815 | ||||||||
| FaxNumber: | 6098157814 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 25MB05959100 | NJ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7091907 | 05 | NJ | MEDICAID |