1053551838 NPI number — DR. JONATHAN PAULL GERTLER JONATHAN GERTLER MD

Table of content: DR. JONATHAN PAULL GERTLER JONATHAN GERTLER MD (NPI 1053551838)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053551838 NPI number — DR. JONATHAN PAULL GERTLER JONATHAN GERTLER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GERTLER
Provider First Name:
JONATHAN
Provider Middle Name:
PAULL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
JONATHAN GERTLER MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053551838
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 WESTCLIFF RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02493-1409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-237-2544
Provider Business Mailing Address Fax Number:
781-237-3225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 WESTCLIFF RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02493-1409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-237-2544
Provider Business Practice Location Address Fax Number:
781-237-3225
Provider Enumeration Date:
03/06/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  57615 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)