Provider Demographics
NPI:1689976029
Name:THOMAS J. GERBNER, PH.D., INC.
Entity Type:Organization
Organization Name:THOMAS J. GERBNER, PH.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:GERBNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:610-667-7667
Mailing Address - Street 1:120 ELLIS RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-1109
Mailing Address - Country:US
Mailing Address - Phone:610-368-3773
Mailing Address - Fax:610-667-7364
Practice Address - Street 1:15 PRESIDENTIAL BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1006
Practice Address - Country:US
Practice Address - Phone:610-667-7667
Practice Address - Fax:610-667-7364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA665133Medicare UPIN