Provider Demographics
NPI:1821054230
Name:GILSON, NOAH R (MD)
Entity Type:Individual
Prefix:DR
First Name:NOAH
Middle Name:R
Last Name:GILSON
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 1:107 MONMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764
Mailing Address - Country:US
Mailing Address - Phone:732-935-1850
Mailing Address - Fax:732-544-0494
Practice Address - Street 1:107 MONMOUTH RD
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764
Practice Address - Country:US
Practice Address - Phone:732-935-1850
Practice Address - Fax:732-544-0494
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2024-03-05
Deactivation Date:2024-03-01
Deactivation Code:
Reactivation Date:2024-03-05
Provider Licenses
StateLicense IDTaxonomies
NJMA477842084N0400X
NJ477842084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3705200Medicaid
C53910Medicare UPIN
NJ502261Medicare ID - Type Unspecified
NJ3705200Medicaid