Provider Demographics
NPI:1285701912
Name:GERSTEIN, MARC H (LIC AC)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:H
Last Name:GERSTEIN
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 GULF RD
Mailing Address - Street 2:
Mailing Address - City:BELCHERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01007-9729
Mailing Address - Country:US
Mailing Address - Phone:860-243-3903
Mailing Address - Fax:
Practice Address - Street 1:81 GULF RD
Practice Address - Street 2:
Practice Address - City:BELCHERTOWN
Practice Address - State:MA
Practice Address - Zip Code:01007-9729
Practice Address - Country:US
Practice Address - Phone:413-374-6756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA165171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist