Basic Information
| Provider Information | |||||||||
| NPI: | 1821278433 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EWING | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 695 US HIGHWAY 46 | ||||||||
| Address2: | STE 400A | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070041568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738268291 | ||||||||
| FaxNumber: | 8889726480 | ||||||||
| Practice Location | |||||||||
| Address1: | 611 COURTYARD DR | ||||||||
| Address2: | BUILDING 600 | ||||||||
| City: | HILLSBOROUGH | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088444256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087220030 | ||||||||
| FaxNumber: | 9087220188 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2007 | ||||||||
| LastUpdateDate: | 09/26/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 25MP00029600 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 527111 | 01 | NJ | MEDICARE RAILROAD | OTHER |