Provider Demographics
NPI:1578825048
Name:GEBERT, JACQUELINE (MSED)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:GEBERT
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 69TH PL
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-2626
Mailing Address - Country:US
Mailing Address - Phone:917-698-1933
Mailing Address - Fax:
Practice Address - Street 1:5820 69TH PL
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-2626
Practice Address - Country:US
Practice Address - Phone:917-698-1933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY840023174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist