Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 029278 | NY |
NPI | 1003905860 |
---|---|
Provider Name | Dr. Andrew Gershon |
First Address | New York, NY 10022-4339 |
Second Address | New York, NY 10022-4339 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 23/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02207725 | (05) | NY |