Healthcare Provider Details

I. General information

NPI: 1790450690
Provider Name (Legal Business Name): GISELLE JOY GERARDO TESTON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 BROADWAY FL 23
NEW YORK NY
10006-1452
US

IV. Provider business mailing address

349 E 149TH ST FL 2
BRONX NY
10451-5603
US

V. Phone/Fax

Practice location:
  • Phone: 888-731-8994
  • Fax:
Mailing address:
  • Phone: 212-965-4826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF421737-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: