Provider Demographics
NPI:1902803471
Name:GUMNIT, ROBERT YALE (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:YALE
Last Name:GUMNIT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 MADISON AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-2055
Mailing Address - Country:US
Mailing Address - Phone:609-261-1660
Mailing Address - Fax:609-261-1779
Practice Address - Street 1:175 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-2038
Practice Address - Country:US
Practice Address - Phone:609-267-0700
Practice Address - Fax:609-261-4801
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017913E207L00000X
NJ25MA03226500207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGU096007OtherPA BLUE SHIELD
NJ2354705Medicaid
PA0006293980002Medicaid
PAGU096007OtherPA BLUE SHIELD
PAE82907Medicare UPIN