MEDICARE: MR. JEFFREY M GERSCH P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	012167-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10035105	OTHER	NY	CDPHP
2	18283	OTHER	NY	HUDSON HEALTH PLAN
3	437780	OTHER	NY	MVP

General Provider Information

NPI Number	:	1013913540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY M GERSCH P.T.

Provider Business Mailing Address
First Line	:	280 ROUTE 299
Second Line	:	STE 1
City	:	HIGHLAND
State	:	NY
Zip	:	12528-2552
Country	:	US
Telephone Number	:	845-691-9169
Fax Number	:	845-691-3864

Provider Business Practice Location Address
First Line	:	280 ROUTE 299
Second Line	:	STE 1
City	:	HIGHLAND
State	:	NY
Zip	:	12528-2552
Country	:	US
Telephone Number	:	845-691-9169
Fax Number	:	845-691-3864

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/08/2007

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