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General NPI Number Information
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NPI Number | 1013702737
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Entity Type | Individual
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Provider Name | KEVIN M GERNAVAGE
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Gender | Male
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Dates
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Enumeration Date | 04/12/2025
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Last Update Date | 04/12/2025
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Provider Practice Location Address
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Address Line | 230 W 125TH ST FRNT 3
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City | NEW YORK
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State | NY
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Zip | 10027-4402
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Country | US
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Telephone | 212-851-1199
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Fax |
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Provider Business Mailing Address
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Address Line | 7104 15TH AVE FL 2
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City | BROOKLYN
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State | NY
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Zip | 11228-2106
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Country | US
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Telephone | 917-617-1504
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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