Provider Demographics
NPI:1528381969
Name:GERSON, STEVEN IRWIN (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:IRWIN
Last Name:GERSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 LESLIE LN
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2318
Mailing Address - Country:US
Mailing Address - Phone:631-543-1597
Mailing Address - Fax:
Practice Address - Street 1:51 BROADWAY
Practice Address - Street 2:
Practice Address - City:GREENLAWN
Practice Address - State:NY
Practice Address - Zip Code:11740-1322
Practice Address - Country:US
Practice Address - Phone:631-261-2233
Practice Address - Fax:631-261-0705
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029499183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist