Provider Demographics
NPI:1194764639
Name:GERBER, LEONARD STUART (DPM)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:STUART
Last Name:GERBER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:243 NORTH RD STE 304
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1173
Mailing Address - Country:US
Mailing Address - Phone:845-471-9410
Mailing Address - Fax:845-471-7372
Practice Address - Street 1:22 FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2422
Practice Address - Country:US
Practice Address - Phone:845-454-0630
Practice Address - Fax:845-454-0637
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY65 003356213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
200053170OtherMVP HEALTH PLAN GROUP IDENTIFIER
547001OtherMVP HEALTHPLAN LEGACY NUMBER
10021259OtherCDPHP LEGACY NUMBER
103301OtherWELLCARE LEGACY NUMBER
5934707OtherAETNA, AETNA US HEALTHCARE LEGACY NUMBER
100179375401OtherUNITED HEALTHCARE LEGACY NUMBER
30061OtherLAST 5 TIN
33D0164140OtherCLIA IDENTIFIER
5102863OtherCCN WORKERS COMP LEGACY NUMBER
0073856OtherGHI ,GHI HMO SELECT LEGACY NUMBER
4316059OtherCARECORE AETNA HEALTH LEGACY NUMBER
CJ2100OtherRAIL ROAD MEDICARE GROUP PIN IDENTIFIER
Y023437OtherTRICARE / CHAMPA/ CHAMPVA LEGACY NUMBER
000405895002OtherBSNENY LEGACY NUMBER
109052400OtherGOVERNMENT WORKERS COMP LEGACY NUMBER
1793754OtherNYS EMPIRE PLAN UNITED HEALTHCARE LEGACY NUMBER
257734OtherUNITED HEALTHCARE GROUP LEGACY NUMBER
408871001OtherBSNENY GROUP LEGACY NUMBER
DUS001OtherOXFORD HEALTHCARE LEGACY NUMBER
LG0P360320OtherBLUE CROSS BLUE SHIELD LEGACY NUMBER
NY007552991Medicaid
2C3717OtherPHS LEGACY NUMBER
0488940001Medicare Oscar/Certification
0073856OtherGHI ,GHI HMO SELECT LEGACY NUMBER
5102863OtherCCN WORKERS COMP LEGACY NUMBER
200053170OtherMVP HEALTH PLAN GROUP IDENTIFIER
4316059OtherCARECORE AETNA HEALTH LEGACY NUMBER
T51081Medicare UPIN