Provider Demographics
NPI:1013309004
Name:GERSHEN, JESSICA MEI
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MEI
Last Name:GERSHEN
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 1:21426 41ST AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2159
Mailing Address - Country:US
Mailing Address - Phone:718-631-1110
Mailing Address - Fax:718-631-1314
Practice Address - Street 1:21426 41ST AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2159
Practice Address - Country:US
Practice Address - Phone:718-631-1110
Practice Address - Fax:718-631-1314
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator