Basic Information
| Provider Information | |||||||||
| NPI: | 1366758724 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KERGE | ||||||||
| FirstName: | MAROL | ||||||||
| MiddleName: | |||||||||
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| Credential: | PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 274 MADISON AVE., SUITE 1501 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122031773 | ||||||||
| FaxNumber: | 6466654427 | ||||||||
| Practice Location | |||||||||
| Address1: | 274 MADISON AVE., SUITE 1501 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122031773 | ||||||||
| FaxNumber: | 6466654427 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2010 | ||||||||
| LastUpdateDate: | 03/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN48572 | RI | N | Nursing Service Providers | Registered Nurse | 163W00000X | 833406-01 | NY | N | Nursing Service Providers | Registered Nurse | 363LP0808X | APRN01516 | RI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 364SP0808X | CAPRN01516 | RI | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health | 364SP0808X | APRN01516 | RI | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health | 363LP0808X | F403911-01 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.