Provider Demographics
NPI:1417175407
Name:GERCHBERG, SETH (OD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:
Last Name:GERCHBERG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 MAMARONECK AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-5301
Mailing Address - Country:US
Mailing Address - Phone:914-949-8900
Mailing Address - Fax:
Practice Address - Street 1:148 MAMARONECK AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-5301
Practice Address - Country:US
Practice Address - Phone:914-949-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA002723152W00000X
NYTUV002723-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist