Provider Demographics
NPI:1609989649
Name:GERSTEIN, JEFFREY M (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:GERSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 RUSHING RIVER CT
Mailing Address - Street 2:
Mailing Address - City:ELVERTA
Mailing Address - State:CA
Mailing Address - Zip Code:95626-9756
Mailing Address - Country:US
Mailing Address - Phone:916-991-3161
Mailing Address - Fax:916-487-6858
Practice Address - Street 1:7700 FOLSOM BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-2608
Practice Address - Country:US
Practice Address - Phone:916-806-1994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0636992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH45851Medicare UPIN
CA00A636992Medicare PIN