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General NPI Number Information
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NPI Number | 1306888169
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Entity Type | Individual
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Provider Name | SHOSHANA YETTA GERLITZ PA
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Gender | Female
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 12/18/2007
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Provider Practice Location Address
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Address Line | 1 HEALTHY WAY
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City | OCEANSIDE
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State | NY
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Zip | 11572-1551
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Country | US
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Telephone | 516-632-3935
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Fax |
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Provider Business Mailing Address
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Address Line | 1041 ROSE ST
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-4744
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Country | US
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Telephone | 718-471-4784
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 007835
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License Number State | NY
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