Organization
NORTH ATLANTIC DIAGNOSTIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLAS TODD GIBBENS M.D. (PRESIDENT/ CEO)
(732) 539-8714
Entity
Organization
Contact information
Practice address
4 SYCAMORE LN, RUMSON, NJ 07760-1035
(732) 539-8714
(732) 933-0379
Mailing address
4 SYCAMORE LN, RUMSON, NJ 07760-1035
(732) 539-8714
(732) 933-0379
Taxonomy
Speciality
Code
Description
License number
State
204R00000X
Electrodiagnostic Medicine Physician
Primary
MA06225500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6581803
—
NJ
Enumeration date
08/16/2011
Last updated
08/17/2011
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