Healthcare Provider Details

I. General information

NPI: 1932545423
Provider Name (Legal Business Name): GERARDO TREJO JR. M.D., M.H.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JERRY TREJO JR. M.D., M.H.S.

II. Dates (important events)

Enumeration Date: 05/11/2013
Last Update Date: 02/29/2024
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

542 WESTPORT AVE
NORWALK CT
06851-4431
US

IV. Provider business mailing address

1345 AVENUE OF THE AMERICAS FL 8
NEW YORK NY
10105-0018
US

V. Phone/Fax

Practice location:
  • Phone: 203-845-4800
  • Fax:
Mailing address:
  • Phone: 908-588-3635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number324744
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number65347
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: