Provider Demographics
NPI:1902869720
Name:SHYPULA, GREGORY JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JOSEPH
Last Name:SHYPULA
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 1:1030 ST GEORGES AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:AVENEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07001-1330
Mailing Address - Country:US
Mailing Address - Phone:732-750-1200
Mailing Address - Fax:732-602-4044
Practice Address - Street 1:1030 ST GEORGES AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:AVENEL
Practice Address - State:NJ
Practice Address - Zip Code:07001-1330
Practice Address - Country:US
Practice Address - Phone:732-750-1200
Practice Address - Fax:732-602-4044
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA50985207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJLS149OtherOXFORD
NJ223175155OtherAETNA
NJ223175155OtherHORIZON
NJ223175155OtherCIGNA
NJ0181056OtherAETNA
NH0531916OtherCIGNA
NJ223175155OtherUNITED HEALTHCARE
NJ223175155OtherUNITED HEALTHCARE
NJSH698441Medicare ID - Type Unspecified