Basic Information
| Provider Information | |||||||||
| NPI: | 1548776008 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GPS PHYSICIAN GROUP OF NEW JERSEY, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 42738 | ||||||||
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| City: | TOWSON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212842738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104947607 | ||||||||
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| Practice Location | |||||||||
| Address1: | 113 ROUTE 73 | ||||||||
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| City: | VOORHEES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568093500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2017 | ||||||||
| LastUpdateDate: | 08/05/2019 | ||||||||
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| AuthorizedOfficialLastName: | SHAPIRO | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP/AREA CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 4108327790 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | NJ | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
No ID Information.