Provider Demographics
NPI:1851718480
Name:WEST, WILLIAM JR
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:WEST
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4455 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-1500
Mailing Address - Country:US
Mailing Address - Phone:856-765-7975
Mailing Address - Fax:888-630-9378
Practice Address - Street 1:4455 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-1500
Practice Address - Country:US
Practice Address - Phone:856-765-7975
Practice Address - Fax:888-630-9378
Is Sole Proprietor?:No
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
146N00000X, 172A00000X
NJ171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No171W00000XOther Service ProvidersContractor
No172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1225388309Medicaid