Provider Demographics
NPI:1881724672
Name:GERSHMAN, IAN (CAC)
Entity type:Individual
Prefix:MR
First Name:IAN
Middle Name:
Last Name:GERSHMAN
Suffix:
Gender:M
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 FIFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-2221
Mailing Address - Country:US
Mailing Address - Phone:609-484-2454
Mailing Address - Fax:
Practice Address - Street 1:9 HARDING HWY
Practice Address - Street 2:
Practice Address - City:PITTSGROVE
Practice Address - State:NJ
Practice Address - Zip Code:08318-4401
Practice Address - Country:US
Practice Address - Phone:856-358-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA4342101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)