MEDICARE: DR. JANET GERSHENGORN PH., D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	01072701	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225171861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANET GERSHENGORN PH., D

Provider Business Mailing Address
First Line	:	400 E 56TH ST
Second Line	:	APT #4P
City	:	NEW YORK
State	:	NY
Zip	:	10022-4147
Country	:	US
Telephone Number	:	212-752-2653
Fax Number	:

Provider Business Practice Location Address
First Line	:	AMSTERDAM NURSING HOME
Second Line	:	1060 AMSTERDAM AVENUE
City	:	NEW YORK
State	:	NY
Zip	:	10025
Country	:	US
Telephone Number	:	212-316-7700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	07/09/2007

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