Provider Demographics
NPI:1831207950
Name:GERHARDT, WILLIAM JAMES (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAMES
Last Name:GERHARDT
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 1:72 W JIMMIE LEEDS RD
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9406
Mailing Address - Country:US
Mailing Address - Phone:609-677-9729
Mailing Address - Fax:609-652-7153
Practice Address - Street 1:1 E NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2340
Practice Address - Country:US
Practice Address - Phone:609-677-9729
Practice Address - Fax:609-652-6270
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA046575002085B0100X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00758309OtherRAILROAD MEDICARE
NJP00236401OtherRAILROAD MEDICARE
NJ2194104Medicaid
NJ083963AMLMedicare PIN
NJ083963ZEKDMedicare PIN
NJC52558Medicare UPIN
NJ2194104Medicaid