=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447205067
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GERALD WEST DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2006
-----------------------------------------------------
Last Update Date | 11/18/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 505 CHESTNUT STREET
-----------------------------------------------------
City | ROSELLE PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-241-0200
-----------------------------------------------------
Fax | 908-241-1615
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 505 CHESTNUT ST
-----------------------------------------------------
City | ROSELLE PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07204-1918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-241-0200
-----------------------------------------------------
Fax | 908-241-1615
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | 22284
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207YS0123X
-----------------------------------------------------
Taxonomy Name | Facial Plastic Surgery Physician
-----------------------------------------------------
License Number | 22284
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | 236854
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------