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General NPI Number Information
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NPI Number | 1740552637
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Entity Type | Individual
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Provider Name | BRIAN GERSON NP
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Gender | Male
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Dates
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Enumeration Date | 02/07/2012
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Last Update Date | 08/16/2019
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Provider Practice Location Address
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Address Line | 375 COMMACK RD UNIT A
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City | DEER PARK
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State | NY
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Zip | 11729-5522
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Country | US
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Telephone | 631-940-0409
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Fax | 631-940-0409
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Provider Business Mailing Address
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Address Line | 2000 FISHER AVE # 22
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City | MERRICK
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State | NY
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Zip | 11566-3407
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Country | US
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Telephone | 516-322-4878
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Fax | 707-880-3209
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F337112-1
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License Number State | NY
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