Provider Demographics
NPI:1639320948
Name:RICHARD J GERSTEIN M D P A
Entity Type:Organization
Organization Name:RICHARD J GERSTEIN M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:GERSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-338-3300
Mailing Address - Street 1:1050 NW 15TH ST
Mailing Address - Street 2:SUITE 103A
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1375
Mailing Address - Country:US
Mailing Address - Phone:561-338-3300
Mailing Address - Fax:561-338-3303
Practice Address - Street 1:1050 NW 15TH ST
Practice Address - Street 2:SUITE 103A
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1375
Practice Address - Country:US
Practice Address - Phone:561-338-3300
Practice Address - Fax:561-338-3303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC66809Medicare UPIN
FLAP889Medicare PIN