Provider Demographics
NPI:1548214836
Name:GERSTLEY, JAMES (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:GERSTLEY
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 1:1 LETHBRIDGE PLZ
Mailing Address - Street 2:ROUTE 17 NORTH, SUITE #20
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-2126
Mailing Address - Country:US
Mailing Address - Phone:201-684-1616
Mailing Address - Fax:
Practice Address - Street 1:111 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-1805
Practice Address - Country:US
Practice Address - Phone:845-727-0828
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20937512085R0001X
NJ25MA066837002085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7792000Medicaid
NY01926094Medicaid
NJ7792000Medicaid
D61292Medicare UPIN
NY9T6381Medicare ID - Type Unspecified