MEDICARE: DR. MARK BENJAMIN GERSTEN MD

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	207R00000X	Internal Medicine Physician	124702	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972589794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK BENJAMIN GERSTEN MD

Provider Business Mailing Address
First Line	:	260 MIDDLE NECK RD
Second Line	:	APT 3B
City	:	GREAT NECK
State	:	NY
Zip	:	11021-1158
Country	:	US
Telephone Number	:	516-482-4174
Fax Number	:

Provider Business Practice Location Address
First Line	:	58 47 FRANCIS LEWIS BLVD
Second Line	:	SUITE 204
City	:	BAYSIDE
State	:	NY
Zip	:	11364
Country	:	US
Telephone Number	:	718-229-6688
Fax Number	:

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

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	08/31/2016

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