MEDICARE: WILLIAM MICHAEL GERBA M.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	208000000X	Pediatrics Physician	124840	NY
2	2080P0207X	Pediatric Hematology & Oncology Physician	124840	NY

General Provider Information

NPI Number	:	1568548949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM MICHAEL GERBA M.D.

Provider Business Mailing Address
First Line	:	935 NORTHERN BLVD
Second Line	:	STE 300
City	:	GREAT NECK
State	:	NY
Zip	:	11021-5309
Country	:	US
Telephone Number	:	516-466-9062
Fax Number	:	516-466-9081

Provider Business Practice Location Address
First Line	:	935 NORTHERN BLVD
Second Line	:	STE 300
City	:	GREAT NECK
State	:	NY
Zip	:	11021-5309
Country	:	US
Telephone Number	:	516-466-9062
Fax Number	:	516-466-9081

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

Provider Enumeration Date	:	10/28/2006
Last Update Date	:	12/20/2021

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