Provider Demographics
NPI:1710052790
Name:GERARD, MARIE G (DC)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:G
Last Name:GERARD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CERENZIA BLVD
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-3627
Mailing Address - Country:US
Mailing Address - Phone:516-616-5187
Mailing Address - Fax:516-616-6655
Practice Address - Street 1:1 CERENZIA BLVD
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-3627
Practice Address - Country:US
Practice Address - Phone:516-616-5187
Practice Address - Fax:516-616-6655
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0075281111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02367242Medicaid
NYX0C361Medicare ID - Type Unspecified
V76199Medicare UPIN