Healthcare Provider Details

I. General information

NPI: 1275679201
Provider Name (Legal Business Name): JONATHAN M. GERBER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 2ND AVE FL 2
NEW YORK NY
10016-4859
US

IV. Provider business mailing address

700 HICKSVILLE RD STE 205
BETHPAGE NY
11714-3472
US

V. Phone/Fax

Practice location:
  • Phone: 646-501-4848
  • Fax: 929-455-9087
Mailing address:
  • Phone:
  • Fax: 212-263-4539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number329301
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number329301
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: