Provider Demographics
NPI:1376723858
Name:GERSHANIK, ESTEBAN (MD, MPH)
Entity Type:Individual
Prefix:
First Name:ESTEBAN
Middle Name:
Last Name:GERSHANIK
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LAKE MARINA DR
Mailing Address - Street 2:APT. #13D
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-1676
Mailing Address - Country:US
Mailing Address - Phone:504-782-5917
Mailing Address - Fax:504-891-8753
Practice Address - Street 1:1430 TULANE AVE # SL-37
Practice Address - Street 2:MED-PEDS RESIDENCY PROGRAN
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2632
Practice Address - Country:US
Practice Address - Phone:504-988-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200587207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1069931Medicaid