Healthcare Provider Details

I. General information

NPI: 1871616482
Provider Name (Legal Business Name): LORI GERSHMAN PA-C, MNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 FULTON AVE
HEMPSTEAD NY
11550-4364
US

IV. Provider business mailing address

10 THE LOCH
ROSLYN NY
11576-1917
US

V. Phone/Fax

Practice location:
  • Phone: 516-750-2500
  • Fax: 516-483-3592
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number002103-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: