Healthcare Provider Details

I. General information

NPI: 1225171861
Provider Name (Legal Business Name): JANET GERSHENGORN PH., D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AMSTERDAM NURSING HOME 1060 AMSTERDAM AVENUE
NEW YORK NY
10025
US

IV. Provider business mailing address

400 E 56TH ST APT #4P
NEW YORK NY
10022-4147
US

V. Phone/Fax

Practice location:
  • Phone: 212-316-7700
  • Fax:
Mailing address:
  • Phone: 212-752-2653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number01072701
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: