Provider Demographics
NPI:1477177608
Name:KERSH, CLEVELAND EDWARD (LAC, LMT)
Entity Type:Individual
Prefix:MR
First Name:CLEVELAND
Middle Name:EDWARD
Last Name:KERSH
Suffix:
Gender:M
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 W 106TH ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-3671
Mailing Address - Country:US
Mailing Address - Phone:929-276-1732
Mailing Address - Fax:
Practice Address - Street 1:211 W 106TH ST APT 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3671
Practice Address - Country:US
Practice Address - Phone:929-276-1732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006121171100000X
NY027643225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist