Provider Demographics
NPI:1669914958
Name:GERSHKOVICH, MARINA (PHD)
Entity type:Individual
Prefix:DR
First Name:MARINA
Middle Name:
Last Name:GERSHKOVICH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:392 CENTRAL PARK W
Mailing Address - Street 2:APT 14L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5860
Mailing Address - Country:US
Mailing Address - Phone:347-419-4747
Mailing Address - Fax:
Practice Address - Street 1:255 W 92ND ST
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-7342
Practice Address - Country:US
Practice Address - Phone:347-708-2522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021844103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral