Healthcare Provider Details

I. General information

NPI: 1760746549
Provider Name (Legal Business Name): CLAUDINE MARIE GEBHARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 06/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 CHESTNUT AVE
MAMARONECK NY
10543-1306
US

IV. Provider business mailing address

435 CHESTNUT AVE
MAMARONECK NY
10543-1306
US

V. Phone/Fax

Practice location:
  • Phone: 914-835-1865
  • Fax: 914-922-9336
Mailing address:
  • Phone: 914-835-1865
  • Fax: 914-922-9336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: