Provider Demographics
NPI:1215980487
Name:GERBERG, BRUCE EDWARD (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:EDWARD
Last Name:GERBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3552
Mailing Address - Country:US
Mailing Address - Phone:631-427-0530
Mailing Address - Fax:631-427-0147
Practice Address - Street 1:41 FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3552
Practice Address - Country:US
Practice Address - Phone:631-427-0530
Practice Address - Fax:631-427-0147
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208752208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA70464OtherMDNY
2C1647OtherHEALTHNET GUARDIAN
2008776OtherAETNA HMO
5220605OtherAETNA PPO
P1021651OtherOXFORD
NY01861034Medicaid
2699380OtherGHI PPO
549131OtherBC
2639504006OtherCIGNA
86113POtherVYTRA
1829012OtherUNITED
208752OtherHIP
2C1647OtherHEALTHNET GUARDIAN