Provider Demographics
NPI:1659517803
Name:LEV G GERTSIK MD INC
Entity Type:Organization
Organization Name:LEV G GERTSIK MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEV
Authorized Official - Middle Name:G
Authorized Official - Last Name:GERTSIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-726-3983
Mailing Address - Street 1:726 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-2807
Mailing Address - Country:US
Mailing Address - Phone:310-726-3983
Mailing Address - Fax:626-441-2497
Practice Address - Street 1:726 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-2807
Practice Address - Country:US
Practice Address - Phone:310-726-3983
Practice Address - Fax:626-441-2497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA549512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA54951AMedicare UPIN