Basic Information
| Provider Information | |||||||||
| NPI: | 1881761054 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAVIOLA | ||||||||
| FirstName: | GERRY | ||||||||
| MiddleName: | F. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1550 PARK AVE | ||||||||
| Address2: | |||||||||
| City: | SOUTH PLAINFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070805565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9735381800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 59 KOCH AVE | ||||||||
| Address2: | |||||||||
| City: | MORRIS PLAINS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079504400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9735381800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 02/26/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 25MA04509700 | NJ | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.