Provider Demographics
NPI:1417109562
Name:GERSHON, LILLIAN (MACCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:LILLIAN
Middle Name:
Last Name:GERSHON
Suffix:
Gender:F
Credentials:MACCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 JERICHO TPKE APT 123
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3012
Mailing Address - Country:US
Mailing Address - Phone:631-334-9623
Mailing Address - Fax:
Practice Address - Street 1:1126 JERICHO TPKE APT 123
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3012
Practice Address - Country:US
Practice Address - Phone:631-334-9623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010585235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist