Provider Demographics
NPI:1457508350
Name:GERSON, RANDI (AUD)
Entity Type:Individual
Prefix:DR
First Name:RANDI
Middle Name:
Last Name:GERSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 3RD AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-1802
Mailing Address - Country:US
Mailing Address - Phone:212-879-3836
Mailing Address - Fax:
Practice Address - Street 1:1421 3RD AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-1802
Practice Address - Country:US
Practice Address - Phone:212-879-3836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY57002002231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist