Provider Demographics
NPI:1932545423
Name:TREJO, GERARDO JR (MD, MHS)
Entity Type:Individual
Prefix:
First Name:GERARDO
Middle Name:
Last Name:TREJO
Suffix:JR
Gender:M
Credentials:MD, MHS
Other - Prefix:
Other - First Name:JERRY
Other - Middle Name:
Other - Last Name:TREJO
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD, MHS
Mailing Address - Street 1:1345 AVENUE OF THE AMERICAS FL 8
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10105-0018
Mailing Address - Country:US
Mailing Address - Phone:908-588-3635
Mailing Address - Fax:
Practice Address - Street 1:542 WESTPORT AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-4431
Practice Address - Country:US
Practice Address - Phone:203-845-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-11
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY324744207Q00000X
CT65347207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine