Provider Demographics
NPI:1295344125
Name:GERSONY, ALYSSA JANE (MSED, COMS, CVRT)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:JANE
Last Name:GERSONY
Suffix:
Gender:F
Credentials:MSED, COMS, CVRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 41ST ST APT 4F
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3906
Mailing Address - Country:US
Mailing Address - Phone:610-937-1983
Mailing Address - Fax:
Practice Address - Street 1:3150 41ST ST APT 4F
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3906
Practice Address - Country:US
Practice Address - Phone:610-937-1983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225CX0006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorOrientation and Mobility Training Provider
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty