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Individual
DR. GARY J. FADEN
Active
Individual
DR. GARY J. FADEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
25MD00114700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
205671
UNIFORMED SERVICES
NJ
01
—
222332380
TAX ID#
NJ
05
—
3011402
—
NJ
01
—
P404738
OXFORD
NJ
Enumeration date
08/09/2006
Last updated
11/26/2007
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