Provider Demographics
NPI:1285076497
Name:GERSH, MARIANNA (MS ED)
Entity type:Individual
Prefix:
First Name:MARIANNA
Middle Name:
Last Name:GERSH
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 E BROADWAY
Mailing Address - Street 2:104J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-5526
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:208 E BROADWAY
Practice Address - Street 2:104J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-5526
Practice Address - Country:US
Practice Address - Phone:917-566-0070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY463279101171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor