Healthcare Provider Details

I. General information

NPI: 1033055884
Provider Name (Legal Business Name): KAITLYN GEARST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 CROSSING WAY
WAYNE NJ
07470-4736
US

IV. Provider business mailing address

1120 CROSSING WAY
WAYNE NJ
07470-4736
US

V. Phone/Fax

Practice location:
  • Phone: 201-207-9070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ15460900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: