Provider Demographics
NPI:1619187580
Name:GUBERMAN, EUGENE (MA)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:
Last Name:GUBERMAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:GENE
Other - Middle Name:
Other - Last Name:GUBERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:26 W 9TH ST
Mailing Address - Street 2:6D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8971
Mailing Address - Country:US
Mailing Address - Phone:908-285-3030
Mailing Address - Fax:
Practice Address - Street 1:26 W 9TH ST
Practice Address - Street 2:6D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8971
Practice Address - Country:US
Practice Address - Phone:908-285-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000410-1102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst