Provider Demographics
NPI:1396806337
Name:NEONATAL MEDICAL GROUP
Entity type:Organization
Organization Name:NEONATAL MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:JORGE
Authorized Official - Last Name:GERSHANIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-896-2229
Mailing Address - Street 1:1303 HENRY CLAY AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118
Mailing Address - Country:US
Mailing Address - Phone:504-896-2229
Mailing Address - Fax:504-896-8835
Practice Address - Street 1:1303 HENRY CLAY AVENUE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118
Practice Address - Country:US
Practice Address - Phone:504-896-2229
Practice Address - Fax:504-896-8835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Multi-Specialty