Provider Demographics
NPI:1770700882
Name:GERBASIO, JOHN (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:GERBASIO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-3208
Mailing Address - Country:US
Mailing Address - Phone:201-617-0308
Mailing Address - Fax:201-420-8399
Practice Address - Street 1:286 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-3013
Practice Address - Country:US
Practice Address - Phone:201-656-4392
Practice Address - Fax:201-420-8399
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01598700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist