Provider Demographics
NPI:1538689377
Name:GESNER, AILEEN CATHERINE (DO)
Entity Type:Individual
Prefix:
First Name:AILEEN
Middle Name:CATHERINE
Last Name:GESNER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AILEEN
Other - Middle Name:CATHERINE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:106 EAST DRIVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-1611
Mailing Address - Country:US
Mailing Address - Phone:631-838-7288
Mailing Address - Fax:
Practice Address - Street 1:1869 BRENTWOOD RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4625
Practice Address - Country:US
Practice Address - Phone:631-416-5480
Practice Address - Fax:631-994-2900
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY304751208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06091809Medicaid