Provider Demographics
NPI:1649233958
Name:GERSHBEIN, ELLEN (DPM)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:GERSHBEIN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3095 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-4241
Mailing Address - Country:US
Mailing Address - Phone:305-642-4044
Mailing Address - Fax:305-642-2320
Practice Address - Street 1:3095 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-4241
Practice Address - Country:US
Practice Address - Phone:305-642-4044
Practice Address - Fax:305-642-2320
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 2333213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390125400Medicaid
FLU42549Medicare UPIN
FL390125400Medicaid