Healthcare Provider Details

I. General information

NPI: 1902184658
Provider Name (Legal Business Name): DAVID GERSHON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2011
Last Update Date: 07/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E 68TH ST
NEW YORK NY
10065-5718
US

IV. Provider business mailing address

215 EAST 68TH STREET
NEW YORK NY
10065
US

V. Phone/Fax

Practice location:
  • Phone: 646-593-7990
  • Fax:
Mailing address:
  • Phone: 646-593-7990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number194701
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: