Provider Demographics
NPI:1487272043
Name:ADVANCED RHEUMATOLOGY OF NJ
Entity type:Organization
Organization Name:ADVANCED RHEUMATOLOGY OF NJ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GONTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-837-7788
Mailing Address - Street 1:1415 QUEEN ANNE RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3521
Mailing Address - Country:US
Mailing Address - Phone:201-837-7788
Mailing Address - Fax:201-837-2077
Practice Address - Street 1:3196 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-2436
Practice Address - Country:US
Practice Address - Phone:201-837-7788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RHEUMATOLOGY ASSOCIATES OF NORTH JERSEY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty