Provider Demographics
NPI:1710080114
Name:ATHERLEY, TREVOR H (MD)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:H
Last Name:ATHERLEY
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 1:201 LYONS AVE
Mailing Address - Street 2:L3
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112
Mailing Address - Country:US
Mailing Address - Phone:973-926-7323
Mailing Address - Fax:973-705-3096
Practice Address - Street 1:201 LYONS AVE
Practice Address - Street 2:L3
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112
Practice Address - Country:US
Practice Address - Phone:973-926-7323
Practice Address - Fax:973-705-3096
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA31166207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2943905Medicaid
NJMA31166OtherSTATE LICENSE
AA8549947OtherDEA
NJMA31166OtherSTATE LICENSE
C56182Medicare UPIN