Provider Demographics
NPI:1275623456
Name:FURST, GERARD J (DPM)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:J
Last Name:FURST
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 TECHNOLOGY DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-4047
Mailing Address - Country:US
Mailing Address - Phone:631-331-8400
Mailing Address - Fax:631-331-8455
Practice Address - Street 1:4 TECHNOLOGY DR
Practice Address - Street 2:SUITE 110
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-4047
Practice Address - Country:US
Practice Address - Phone:631-331-8400
Practice Address - Fax:631-331-8455
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN2792213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist