Provider Demographics
NPI:1457424137
Name:DEVLIN, GERALD PAUL
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:PAUL
Last Name:DEVLIN
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 1:422 STUYVESANT AVENUE
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-2326
Mailing Address - Country:US
Mailing Address - Phone:201-935-4577
Mailing Address - Fax:201-935-8893
Practice Address - Street 1:422 STUYVESANT AVENUE
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-2326
Practice Address - Country:US
Practice Address - Phone:201-935-4577
Practice Address - Fax:201-935-8893
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ092181223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
047704QL8OtherPIN MEDICARE
T77595Medicare UPIN