Provider Demographics
NPI:1174549950
Name:MASLOW, GREGORY S (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:S
Last Name:MASLOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 MANTUA PIKE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096
Mailing Address - Country:US
Mailing Address - Phone:856-845-4601
Mailing Address - Fax:856-848-5751
Practice Address - Street 1:1007 MANTUA PIKE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096
Practice Address - Country:US
Practice Address - Phone:856-845-4601
Practice Address - Fax:856-848-5751
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ29363207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
007935300OtherAMERIHEALTH
NJ2893703Medicaid
0030252OtherAETNA
NJ101350Medicare ID - Type Unspecified
0030252OtherAETNA