Provider Demographics
NPI:1265607931
Name:J GERSCH PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:J GERSCH PHYSICAL THERAPY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GERSCH
Authorized Official - Suffix:SR
Authorized Official - Credentials:PT
Authorized Official - Phone:845-691-9169
Mailing Address - Street 1:280 ROUTE 299, SUITE 1
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-2551
Mailing Address - Country:US
Mailing Address - Phone:845-691-9169
Mailing Address - Fax:
Practice Address - Street 1:280 ROUTE 299 STE 1
Practice Address - Street 2:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012167-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQN5971Medicare UPIN