Provider Demographics
NPI:1790415941
Name:LEBRUN, GERALDA
Entity Type:Individual
Prefix:
First Name:GERALDA
Middle Name:
Last Name:LEBRUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MARION ST
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10918-8206
Mailing Address - Country:US
Mailing Address - Phone:845-269-1576
Mailing Address - Fax:
Practice Address - Street 1:4 MARION ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10918-8206
Practice Address - Country:US
Practice Address - Phone:845-269-1576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-12
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)