Provider Demographics
NPI:1740552637
Name:GERSON, BRIAN (NP)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:GERSON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 FISHER AVE # 22
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3407
Mailing Address - Country:US
Mailing Address - Phone:516-322-4878
Mailing Address - Fax:707-880-3209
Practice Address - Street 1:375 COMMACK RD UNIT A
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-5522
Practice Address - Country:US
Practice Address - Phone:631-940-0409
Practice Address - Fax:631-940-0409
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337112-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily