Ira Gouterman M.D., PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

MA035818 Issued in NJ

Legal business name

IRA GOUTERMAN M.D., PA

Doing business as

Ira H. Gouterman M.D., PA

Practice address

30 Westville Ave
Caldwell, NJ 07006-5602

Phone

(973) 228-6866

Fax

(973) 228-4133

NPI assigned

Nov 13, 2006

Last updated

Jan 2, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ira Herman Gouterman, M.D

Title

President

Phone

(973) 228-6866

Specialties & licenses 1

Addresses

Other names 1

• Ira H. Gouterman M.D., PA Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Melissa Miao, PA-C

  • Medical Physician Assistant
  • Kearny, NJ
  • NPI 1588924922
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357084800000",
    "number": "1295806123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 WESTVILLE AVE",
            "city": "CALDWELL",
            "state": "NJ",
            "postal_code": "070065602",
            "telephone_number": "973-228-6866",
            "fax_number": "973-228-4133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 WESTVILLE AVE",
            "city": "CALDWELL",
            "state": "NJ",
            "postal_code": "070065602",
            "telephone_number": "973-228-6866",
            "fax_number": "973-228-4133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IRA GOUTERMAN M.D., PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2013-01-02",
        "status": "A",
        "authorized_official_last_name": "GOUTERMAN",
        "authorized_official_first_name": "IRA",
        "authorized_official_middle_name": "HERMAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "973-228-6866",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "NJ",
            "license": "MA035818",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ira H. Gouterman M.D., PA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Patricia Marie Jamison, D.C.
• Jennifer Ra LLC (Ra Wellness)

• Dermatology Physician in Caldwell, NJ
• Providers in Caldwell, NJ by specialty
• Dermatology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.