Provider Demographics
NPI:1326914813
Name:GAITHER, THEODORE JAMES WILLIAM
Entity type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:JAMES WILLIAM
Last Name:GAITHER
Suffix:
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 1:92 AMETHYST WAY
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08823-1657
Mailing Address - Country:US
Mailing Address - Phone:732-829-6370
Mailing Address - Fax:
Practice Address - Street 1:500 PATERSON PLANK RD # 1015
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-3416
Practice Address - Country:US
Practice Address - Phone:732-829-6370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA29785020347C00000X, 347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
No347C00000XTransportation ServicesPrivate Vehicle