Healthcare Provider Details

I. General information

NPI: 1912073610
Provider Name (Legal Business Name): GERSCH ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 08/22/2020
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: DR. STANLEY GERSCH
Title or Position: OWNER
Credential: DMD
Phone: 908-233-8668