Provider Demographics
NPI:1740311208
Name:GERSTENFELD, MICHAEL LANCE (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LANCE
Last Name:GERSTENFELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 MILL PLAIN RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-5140
Mailing Address - Country:US
Mailing Address - Phone:203-297-6120
Mailing Address - Fax:203-297-6122
Practice Address - Street 1:46 MILL PLAIN RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-5140
Practice Address - Country:US
Practice Address - Phone:203-297-6120
Practice Address - Fax:203-297-6122
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2011-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT31959207QA0505X, 2083P0901X
CT031959204C00000X, 207R00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine