Provider Demographics
NPI:1013913540
Name:GERSCH, JEFFREY M (PT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:M
Last Name:GERSCH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 ROUTE 299
Mailing Address - Street 2:STE 1
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-2552
Mailing Address - Country:US
Mailing Address - Phone:845-691-9169
Mailing Address - Fax:845-691-3864
Practice Address - Street 1:280 ROUTE 299
Practice Address - Street 2:STE 1
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-2552
Practice Address - Country:US
Practice Address - Phone:845-691-9169
Practice Address - Fax:845-691-3864
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012167-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10035105OtherCDPHP
NY18283OtherHUDSON HEALTH PLAN
NY437780OtherMVP
NY18283OtherHUDSON HEALTH PLAN