Provider Demographics
NPI:1235164997
Name:L S GERBER DPM & C BROMLEY DPM PC
Entity Type:Organization
Organization Name:L S GERBER DPM & C BROMLEY DPM PC
Other - Org Name:LEONARD S GERBER DPM & CHRISTOPHER BROMLEY DPM PC
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-454-0630
Mailing Address - Street 1:22 FAIRMONT AVE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2422
Mailing Address - Country:US
Mailing Address - Phone:845-454-0630
Mailing Address - Fax:845-454-0637
Practice Address - Street 1:22 FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2422
Practice Address - Country:US
Practice Address - Phone:845-454-0630
Practice Address - Fax:845-454-0637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY65 017501213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1396784849OtherNPI: FLORENCE GABRIELLE SUMMERS DPM
1538163290OtherNPI CHRISTOPHER KENT BROMLEY DPM
1538163290OtherNPI: AUDRA ROCHELLE SIEGEL DPM
30061OtherTAX ID LAST 5 DIGITS
1194764639OtherNPI LEONARD STUART GERBER DPM
RAIL ROAD ME GRP IDOtherCJ2100
NY1528073822OtherNPI: DANY YOSEF JABBOUR DPM
0488940001Medicare Oscar/Certification
1538163290OtherNPI CHRISTOPHER KENT BROMLEY DPM
1194764639OtherNPI LEONARD STUART GERBER DPM
0488940001Medicare NSC