Provider Demographics
NPI:1255517710
Name:DERSOVITZ, GIL M (PT, OTR/L)
Entity type:Individual
Prefix:MR
First Name:GIL
Middle Name:M
Last Name:DERSOVITZ
Suffix:
Gender:M
Credentials:PT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 DONALDSON ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2521
Mailing Address - Country:US
Mailing Address - Phone:917-613-6801
Mailing Address - Fax:866-734-1463
Practice Address - Street 1:324 DONALDSON ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2521
Practice Address - Country:US
Practice Address - Phone:917-613-6801
Practice Address - Fax:866-734-1463
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017930225100000X
NJ40QA01130400225100000X
NY012347225X00000X
NJ46TR00382200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist