Provider Demographics
NPI:1295873347
Name:GERDVIL, CHRISTINE A
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:A
Last Name:GERDVIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 VAN BUREN AVE
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-3260
Mailing Address - Country:US
Mailing Address - Phone:631-467-3024
Mailing Address - Fax:
Practice Address - Street 1:6 VAN BUREN AVE
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-3260
Practice Address - Country:US
Practice Address - Phone:631-467-3024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist