Healthcare Provider Details

I. General information

NPI: 1891738811
Provider Name (Legal Business Name): ROSE B GHERSIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

293 ROUTE 100 SUITE 104
SOMERS NY
10589
US

IV. Provider business mailing address

8 DALY CROSS RD
MOUNT KISCO NY
10549-3606
US

V. Phone/Fax

Practice location:
  • Phone: 914-277-3360
  • Fax: 914-277-1813
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number174705
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: