Provider Demographics
NPI:1164498010
Name:HAYKEN, GERALD D (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:D
Last Name:HAYKEN
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 1:204 ARK RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054
Mailing Address - Country:US
Mailing Address - Phone:856-235-7080
Mailing Address - Fax:856-273-0402
Practice Address - Street 1:204 ARK RD
Practice Address - Street 2:SUITE 105
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054
Practice Address - Country:US
Practice Address - Phone:856-235-7080
Practice Address - Fax:856-273-0402
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03849900207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C58559Medicare UPIN
160528AZDMedicare ID - Type Unspecified