Provider Demographics
NPI:1396809935
Name:GERSHON, ELLEN M (PT)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:M
Last Name:GERSHON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 CHESTNUT LN
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-3716
Mailing Address - Country:US
Mailing Address - Phone:516-292-7937
Mailing Address - Fax:
Practice Address - Street 1:1 DELAWARE DR
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1116
Practice Address - Country:US
Practice Address - Phone:516-586-1700
Practice Address - Fax:516-586-1688
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004701-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist