Basic Information
| Provider Information | |||||||||
| NPI: | 1477617710 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LINK | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | GARY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 318 CHRIS GAUPP DRIVE | ||||||||
| Address2: | |||||||||
| City: | GALLOWAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082053685 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094049900 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 318 CHRIS GAUPP DRIVE | ||||||||
| Address2: | |||||||||
| City: | GALLOWAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094049900 | ||||||||
| FaxNumber: | 6094043653 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2006 | ||||||||
| LastUpdateDate: | 06/14/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MT186817 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | MD434614 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0001X | MD434614 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | 207RC0001X | 25MA11027200 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | 102738151 | 05 | PA | MEDICAID | PO1147098 | 01 | PA | RR MEDICARE | OTHER |