Provider Demographics
NPI:1760740021
Name:GERSHON, PENNY SUE (PT)
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:SUE
Last Name:GERSHON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 COE FARM RD
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-2908
Mailing Address - Country:US
Mailing Address - Phone:845-494-5293
Mailing Address - Fax:
Practice Address - Street 1:5 COE FARM RD
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-2908
Practice Address - Country:US
Practice Address - Phone:845-494-5293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010248-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist