Individual
DR. JUSTIN GUTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1255 BROAD ST STE 104, BLOOMFIELD, NJ 07003-3061
(973) 707-5632
(973) 707-7349
Mailing address
1 CORPORATE DR, WAYNE, NJ 07470-3112
(973) 987-3380
(973) 987-3379
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
25MA10052400
NJ
207W00000X
Ophthalmology Physician
P6404
TX
207WX0107X
Retina Specialist (Ophthalmology) Physician
25MA10052400
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
579530
—
NJ
Enumeration date
06/03/2010
Last updated
03/10/2022
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