Provider Demographics
NPI:1528454782
Name:GERVIS, AMY BROOKE (MA, SLP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:BROOKE
Last Name:GERVIS
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 5TH AVE
Mailing Address - Street 2:APT. 10E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6539
Mailing Address - Country:US
Mailing Address - Phone:201-400-8117
Mailing Address - Fax:
Practice Address - Street 1:34 E 29TH ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-7918
Practice Address - Country:US
Practice Address - Phone:212-679-4319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist