Provider Demographics
NPI:1790986453
Name:JEFFREY GERBER D.P.M., P.C.
Entity Type:Organization
Organization Name:JEFFREY GERBER D.P.M., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GERBER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-921-5949
Mailing Address - Street 1:8 HERRICK AVE
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-6716
Mailing Address - Country:US
Mailing Address - Phone:516-921-5949
Mailing Address - Fax:
Practice Address - Street 1:87 COLD SPRING RD
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-3150
Practice Address - Country:US
Practice Address - Phone:516-921-5949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002849213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00405041Medicaid
NYT5092Medicare UPIN
NYPTW941Medicare ID - Type Unspecified