Provider Demographics
NPI:1023440476
Name:ST. PIERRE, DANIEL GERBER (PA)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:GERBER
Last Name:ST. PIERRE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:MR
Other - First Name:DANIEL
Other - Middle Name:GERBER
Other - Last Name:ST.PIERRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:471 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL HALL
Mailing Address - State:NY
Mailing Address - Zip Code:10916-2606
Mailing Address - Country:US
Mailing Address - Phone:845-381-7660
Mailing Address - Fax:
Practice Address - Street 1:471 RIDGE RD
Practice Address - Street 2:
Practice Address - City:CAMPBELL HALL
Practice Address - State:NY
Practice Address - Zip Code:10916-2606
Practice Address - Country:US
Practice Address - Phone:845-381-7660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007305363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant