Provider Demographics
NPI:1336317577
Name:GERSHON NEY MD PLLC
Entity Type:Organization
Organization Name:GERSHON NEY MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR/CHIEF MEDICAL OFFIC
Authorized Official - Prefix:DR
Authorized Official - First Name:GERSHON
Authorized Official - Middle Name:C
Authorized Official - Last Name:NEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-352-3370
Mailing Address - Street 1:4518 LITTLE NECK PKWY
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1427
Mailing Address - Country:US
Mailing Address - Phone:718-352-3370
Mailing Address - Fax:718-352-3375
Practice Address - Street 1:4518 LITTLE NECK PKWY
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-1427
Practice Address - Country:US
Practice Address - Phone:718-352-3370
Practice Address - Fax:718-352-3375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183541174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01263152Medicaid
NY01263152Medicaid
NYE83632Medicare UPIN