Provider Demographics
NPI:1760755847
Name:GERSHON PAIN SPECIALISTS, LLC
Entity Type:Organization
Organization Name:GERSHON PAIN SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GERSHON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-496-2050
Mailing Address - Street 1:1133 FIRST COLONIAL RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2402
Mailing Address - Country:US
Mailing Address - Phone:757-496-2050
Mailing Address - Fax:757-689-4357
Practice Address - Street 1:1133 FIRST COLONIAL RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2402
Practice Address - Country:US
Practice Address - Phone:757-496-2050
Practice Address - Fax:757-689-4357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-20
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048068332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1871710798Medicaid
6668240001OtherMEDICARE NSC
6668240001OtherMEDICARE NSC