1477592228 NPI number — MICHAEL YUAN GAO M.D.

Table of content: MICHAEL YUAN GAO M.D. (NPI 1477592228)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477592228 NPI number — MICHAEL YUAN GAO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAO
Provider First Name:
MICHAEL
Provider Middle Name:
YUAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GAO
Provider Other First Name:
YUAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477592228
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
49 VERONICA AVE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
SOMERSET
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08873-6802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-246-0495
Provider Business Mailing Address Fax Number:
732-246-0503

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
49 VERONICA AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08873-6802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-246-0495
Provider Business Practice Location Address Fax Number:
732-246-0503
Provider Enumeration Date:
06/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  25MA07601400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0038091 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".