Provider Demographics
NPI:1669624086
Name:WEST RIVER MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:WEST RIVER MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GATELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-426-6864
Mailing Address - Street 1:323 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-4829
Mailing Address - Country:US
Mailing Address - Phone:845-426-6864
Mailing Address - Fax:
Practice Address - Street 1:323 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-4829
Practice Address - Country:US
Practice Address - Phone:845-426-6864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty