Provider Demographics
NPI:1215696851
Name:GERALD, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:GERALD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 CENTRAL PARK W STE 1I
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6054
Mailing Address - Country:US
Mailing Address - Phone:212-874-4959
Mailing Address - Fax:
Practice Address - Street 1:211 CENTRAL PARK W STE 1I
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6054
Practice Address - Country:US
Practice Address - Phone:212-874-4959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008182-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist