Healthcare Provider Details

I. General information

NPI: 1700833399
Provider Name (Legal Business Name): GERSON ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 12/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10551 DECATUR RD SUITE 200
PHILADELPHIA PA
19154-3800
US

IV. Provider business mailing address

2837 SOUTHAMPTON RD
PHILADELPHIA PA
19154-1206
US

V. Phone/Fax

Practice location:
  • Phone: 215-637-6800
  • Fax: 215-637-7967
Mailing address:
  • Phone: 215-637-6800
  • Fax: 215-637-7967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD016803E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number6000006361
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BENJAMIN GERSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 215-637-6800