Provider Demographics
NPI:1679120612
Name:MICHEL, GERTHY (NP)
Entity Type:Individual
Prefix:
First Name:GERTHY
Middle Name:
Last Name:MICHEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GERTHY
Other - Middle Name:
Other - Last Name:JEAN-CHARLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:3 OAK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-2714
Mailing Address - Country:US
Mailing Address - Phone:845-659-6163
Mailing Address - Fax:
Practice Address - Street 1:161 FORT WASHINGTON AVE FL 8
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3729
Practice Address - Country:US
Practice Address - Phone:212-342-1155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-23
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01029600363LF0000X
NY342796363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily