Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 22284 | NJ |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 236854 | NY |
N | 207YS0123X | Facial Plastic Surgeon | 22284 | NJ |
NPI | 1447205067 |
---|---|
Provider Name | Dr. Gerald West |
First Address | Roselle Park, NJ 07204-1918 |
Second Address | Roselle Park, NJ 07204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 18/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0729169013 | CIGNA (01) | NJ |
25659 | AETNA (01) | NJ |
E61804 | (02) |