Provider Demographics
NPI:1285776799
Name:MORGAN, GERRY G
Entity type:Individual
Prefix:MRS
First Name:GERRY
Middle Name:G
Last Name:MORGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HILL PARK AVE
Mailing Address - Street 2:APT. A
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3766
Mailing Address - Country:US
Mailing Address - Phone:516-482-7511
Mailing Address - Fax:
Practice Address - Street 1:7 HILL PARK AVE
Practice Address - Street 2:APT. A
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3766
Practice Address - Country:US
Practice Address - Phone:516-482-7511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005768-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist