Healthcare Provider Details

I. General information

NPI: 1235205923
Provider Name (Legal Business Name): STANLEY GERSCH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

547 E BROAD ST
WESTFIELD NJ
07090-2107
US

IV. Provider business mailing address

547 E BROAD ST
WESTFIELD NJ
07090-2107
US

V. Phone/Fax

Practice location:
  • Phone: 908-233-8668
  • Fax:
Mailing address:
  • Phone: 908-233-8668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number22DI011485000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: