Provider Demographics
NPI:1740737972
Name:SEPTIMUS, GERALD (PHD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:
Last Name:SEPTIMUS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:YEHUDA
Other - Middle Name:
Other - Last Name:SEPTIMUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:14202 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11351-3000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5340
Practice Address - Country:US
Practice Address - Phone:516-829-9666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program