Healthcare Provider Details

I. General information

NPI: 1447345731
Provider Name (Legal Business Name): JEFFREY GERSON MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 12/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 GREAT OAKS BLVD
ALBANY NY
12203-5953
US

IV. Provider business mailing address

112 GREAT OAKS BLVD
ALBANY NY
12203-5953
US

V. Phone/Fax

Practice location:
  • Phone: 518-862-1332
  • Fax:
Mailing address:
  • Phone: 518-862-1332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY R GERSON
Title or Position: OWNER
Credential: MD
Phone: 518-862-1332