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1497839062 NPI number — GEOFFREY DAVID GERSTEIN LPT

NPI Number: 1497839062
Health Care Provider/Practitioner: GEOFFREY DAVID GERSTEIN LPT

Information about “1497839062” NPI (GEOFFREY DAVID GERSTEIN LPT) exists in 1497839062 in HTML format HTML  |  1497839062 in plain Text format TXT  |  1497839062 in PDF (Portable Document Format) PDF  |  1497839062 in an XML format XML  formats.

NPI Number : 1497839062 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1497839062",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GERSTEIN",
    "FirstName": "GEOFFREY",
    "MiddleName": "DAVID",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "31946 MISSION TRL STE B",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAKE ELSINORE",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92530-4539",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "951-471-4300",
    "MailingAddressFaxNumber": "951-674-6431",
    "FirstLinePracticeLocationAddress": "31946 MISSION TRL STE B",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAKE ELSINORE",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92530-4539",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "951-471-4300",
    "PracticeLocationAddressFaxNumber": "951-674-6431",
    "EnumerationDate": "10/24/2006",
    "LastUpdateDate": "07/21/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "171M00000X",
        "TaxonomyName": "Case Manager/Care Coordinator",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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