Provider Demographics
NPI:1538128608
Name:GERSHON, JULIE STEINER (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:STEINER
Last Name:GERSHON
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 1:40 HART ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1743
Mailing Address - Country:US
Mailing Address - Phone:860-229-2059
Mailing Address - Fax:860-229-8495
Practice Address - Street 1:20 ARCH RD.
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-4202
Practice Address - Country:US
Practice Address - Phone:860-673-1955
Practice Address - Fax:860-271-8025
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT358462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010035846CT21OtherANTHEM BC/BS
CT300109311OtherRAILROAD MEDICARE
CT300117739OtherRAILROAD MEDICARE
CT001358466Medicaid
CT010035846CT19OtherANTHEM BC/BS
CT010035846CT22OtherANTHEM BC/BS
CT1538128608Medicaid
CT010035846CT16OtherANTHEM BC/BS
CT300117752OtherRAILROAD MEDICARE
CT010035846CT17OtherANTHEM BC/BS
CT010035846CT23OtherANTHEM BC/BS
CT300117747OtherRAILROAD MEDICARE
CT300117768OtherRAILROAD MEDICARE
CT001358466Medicaid
CT300002872Medicare PIN
CT300117752OtherRAILROAD MEDICARE
CT1538128608Medicaid
CT300003810Medicare PIN
CT300002868Medicare PIN
CT300002870Medicare PIN
CT300003133Medicare PIN
CT300002867Medicare PIN