Provider Demographics
NPI:1407939838
Name:GERSHENGORINA, SOFYA (MD)
Entity Type:Individual
Prefix:DR
First Name:SOFYA
Middle Name:
Last Name:GERSHENGORINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 AVENUE J
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-3808
Mailing Address - Country:US
Mailing Address - Phone:718-253-7474
Mailing Address - Fax:718-253-7064
Practice Address - Street 1:1811 AVENUE J
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-3808
Practice Address - Country:US
Practice Address - Phone:718-253-7474
Practice Address - Fax:718-253-7064
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214489208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics