Provider Demographics
NPI:1588842439
Name:GERA, CHARU (DPT)
Entity Type:Individual
Prefix:
First Name:CHARU
Middle Name:
Last Name:GERA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MRS
Other - First Name:CHARU
Other - Middle Name:
Other - Last Name:ST JEAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:6623 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4658
Mailing Address - Country:US
Mailing Address - Phone:516-996-7473
Mailing Address - Fax:
Practice Address - Street 1:6623 AUSTIN ST
Practice Address - Street 2:APT 4A
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4658
Practice Address - Country:US
Practice Address - Phone:516-996-7473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-02
Last Update Date:2012-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027266-1225100000X, 2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY027266-1OtherPHYSICAL THERAPIST