Healthcare Provider Details

I. General information

NPI: 1891100517
Provider Name (Legal Business Name): ZELDA JENNIFAY GHERSIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 01/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2621
US

IV. Provider business mailing address

55 FRUIT STREET GRAY BIGELOW 6
BOSTON MA
02114-2696
US

V. Phone/Fax

Practice location:
  • Phone: 973-754-2543
  • Fax:
Mailing address:
  • Phone: 914-393-2333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number270662
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number270662
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: