Provider Demographics
NPI:1447205067
Name:WEST, GERALD (DO)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:
Last Name:WEST
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:ROSELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07204-1918
Mailing Address - Country:US
Mailing Address - Phone:908-241-0200
Mailing Address - Fax:908-241-1615
Practice Address - Street 1:505 CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:ROSELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07204
Practice Address - Country:US
Practice Address - Phone:908-241-0200
Practice Address - Fax:908-241-1615
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22284207Y00000X, 207YS0123X
NY236854207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25659OtherAETNA
NJ0729169013OtherCIGNA
NJ25659OtherAETNA
NJ041863A8YMedicare ID - Type Unspecified