Provider Demographics
NPI:1750450748
Name:WEST, EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:
Last Name:WEST
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 1:115 CENTRAL PARK W
Mailing Address - Street 2:SUITE 15
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4198
Mailing Address - Country:US
Mailing Address - Phone:212-496-6510
Mailing Address - Fax:212-496-6582
Practice Address - Street 1:115 CENTRAL PARK WEST
Practice Address - Street 2:SUITE 15
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4198
Practice Address - Country:US
Practice Address - Phone:212-496-6510
Practice Address - Fax:212-496-6582
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1915522084P0800X, 2084P2900X, 208U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Not Answered208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY191552OtherNY STATE MEDICAL LICENCE
NY242861Medicare ID - Type UnspecifiedMEDICARE BC BS
NYG08528Medicare UPIN