Provider Demographics
NPI:1891709093
Name:GESSNER, WILLIAM JAY (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAY
Last Name:GESSNER
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 1:133 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570-2006
Mailing Address - Country:US
Mailing Address - Phone:603-752-2040
Mailing Address - Fax:603-752-3862
Practice Address - Street 1:2 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:NH
Practice Address - Zip Code:03581-1502
Practice Address - Country:US
Practice Address - Phone:603-466-2741
Practice Address - Fax:603-466-2953
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156643207Q00000X
NH5987207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3077633Medicaid
NYF63143Medicare UPIN
NY80H782Medicare ID - Type UnspecifiedMEDICARE ID
NH1891709093Medicare PIN