Provider Demographics
NPI:1740391580
Name:GERSTEIN, EDGAR (MD)
Entity type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:
Last Name:GERSTEIN
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 1:8 PRESIDENTIAL DR E
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-4044
Mailing Address - Country:US
Mailing Address - Phone:516-681-4347
Mailing Address - Fax:516-827-5301
Practice Address - Street 1:8 PRESIDENTIAL DR E
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4044
Practice Address - Country:US
Practice Address - Phone:516-681-4347
Practice Address - Fax:516-827-5301
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1409082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01070768Medicaid
NYD83243Medicare UPIN
NY01070768Medicaid