Healthcare Provider Details

I. General information

NPI: 1306170428
Provider Name (Legal Business Name): CLAUDIA HERLINDA GERIS P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 09/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4335 HYLAN BLVD
STATEN ISLAND NY
10312-6529
US

IV. Provider business mailing address

4335 HYLAN BLVD
STATEN ISLAND NY
10312-6529
US

V. Phone/Fax

Practice location:
  • Phone: 718-227-3810
  • Fax: 718-608-9082
Mailing address:
  • Phone: 718-227-3810
  • Fax: 718-608-9082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number006939
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: