Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225400000X | Rehabilitation Practitioner | ||
Y | 225CX0006X | Orientation and Mobility Training Provider |
NPI | 1295344125 |
---|---|
Provider Name | Alyssa Jane Gersony |
First Address | Astoria, NY 11103-3906 |
Second Address | Astoria, NY 11103-3906 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2020 |
Last Update Date | 02/11/2020 |