Provider Demographics
NPI:1952454118
Name:GERTNER, JODY R (MS, CCC)
Entity type:Individual
Prefix:MRS
First Name:JODY
Middle Name:R
Last Name:GERTNER
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 BELLMORE AVE
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-4327
Mailing Address - Country:US
Mailing Address - Phone:516-776-5659
Mailing Address - Fax:516-785-0264
Practice Address - Street 1:2815 BELLMORE AVE
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-4327
Practice Address - Country:US
Practice Address - Phone:516-785-0264
Practice Address - Fax:516-783-8533
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003166-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist