Provider Demographics
NPI:1124221486
Name:GERSHKOVICH MEDICINE, PC
Entity Type:Organization
Organization Name:GERSHKOVICH MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GERSHKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-234-3558
Mailing Address - Street 1:805 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-5701
Mailing Address - Country:US
Mailing Address - Phone:718-851-2916
Mailing Address - Fax:
Practice Address - Street 1:805 E 3RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-5701
Practice Address - Country:US
Practice Address - Phone:718-851-2916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199898208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty