Provider Demographics
NPI:1609830231
Name:GERSON, SIDNEY (PT)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:
Last Name:GERSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 2ND AVE
Mailing Address - Street 2:301
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-5615
Mailing Address - Country:US
Mailing Address - Phone:212-777-2527
Mailing Address - Fax:
Practice Address - Street 1:380 2ND AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5615
Practice Address - Country:US
Practice Address - Phone:212-777-2527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005670225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ52881Medicare ID - Type Unspecified
NYQ52881Medicare PIN