Provider Demographics
NPI:1447223201
Name:GERSHMAN, LARISA K (MD)
Entity Type:Individual
Prefix:DR
First Name:LARISA
Middle Name:K
Last Name:GERSHMAN
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 1:191 HAMBURG TPKE
Mailing Address - Street 2:2B
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07442-2332
Mailing Address - Country:US
Mailing Address - Phone:973-248-9446
Mailing Address - Fax:973-248-9445
Practice Address - Street 1:191 HAMBURG TPKE
Practice Address - Street 2:2B
Practice Address - City:POMPTON LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07442-2332
Practice Address - Country:US
Practice Address - Phone:973-248-9446
Practice Address - Fax:973-248-9445
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07011700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ092051Medicare ID - Type Unspecified
NJH02020Medicare UPIN