Provider Demographics
NPI:1639493976
Name:GERSHELL, LELAND (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:LELAND
Middle Name:
Last Name:GERSHELL
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E 77TH ST
Mailing Address - Street 2:APT 9F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-2069
Mailing Address - Country:US
Mailing Address - Phone:212-737-6154
Mailing Address - Fax:
Practice Address - Street 1:201 E 77TH ST
Practice Address - Street 2:APT 9F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-2069
Practice Address - Country:US
Practice Address - Phone:212-737-6154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230701208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice