=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164575510
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IRA HARVEY GERSON L.C.S.W.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1901 1ST AVE 4M17
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10029-7404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-423-8259
-----------------------------------------------------
Fax | 212-423-6388
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 473 FDR DR K604
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10002-2024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-533-4988
-----------------------------------------------------
Fax | 212-423-6534
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | R016541-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------