Provider Demographics
NPI:1548211246
Name:CHRISTOPHER P GODEK MD PC
Entity type:Organization
Organization Name:CHRISTOPHER P GODEK MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:P
Authorized Official - Last Name:GODEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-281-1988
Mailing Address - Street 1:1430 HOOPER AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2895
Mailing Address - Country:US
Mailing Address - Phone:732-281-1988
Mailing Address - Fax:732-281-1977
Practice Address - Street 1:1430 HOOPER AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2895
Practice Address - Country:US
Practice Address - Phone:732-281-1988
Practice Address - Fax:732-281-1977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8272107Medicaid
NJ8272107Medicaid
NJ038505Medicare PIN