MEDICARE: MRS. ELLEN M GERSHON PT

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	225100000X	Physical Therapist	004701-1	NY

General Provider Information

NPI Number	:	1396809935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELLEN M GERSHON PT

Provider Business Mailing Address
First Line	:	402 CHESTNUT LN
Second Line	:
City	:	EAST MEADOW
State	:	NY
Zip	:	11554-3716
Country	:	US
Telephone Number	:	516-292-7937
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 DELAWARE DR
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1116
Country	:	US
Telephone Number	:	516-586-1700
Fax Number	:	516-586-1688

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	07/08/2007

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