Provider Demographics
NPI:1811292527
Name:NERSTEN, BROOKE M (MPT)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:M
Last Name:NERSTEN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E GATE BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2105
Mailing Address - Country:US
Mailing Address - Phone:516-745-8050
Mailing Address - Fax:516-745-8055
Practice Address - Street 1:800 E GATE BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-2105
Practice Address - Country:US
Practice Address - Phone:516-745-8050
Practice Address - Fax:516-745-8055
Is Sole Proprietor?:No
Enumeration Date:2011-01-11
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025717172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker