Basic Information
| Provider Information | |||||||||
| NPI: | 1376723858 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GERSHANIK | ||||||||
| FirstName: | ESTEBAN | ||||||||
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| Credential: | M.D., M.P.H. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 LAKE MARINA DR | ||||||||
| Address2: | APT. #13D | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701241676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5047825917 | ||||||||
| FaxNumber: | 5048918753 | ||||||||
| Practice Location | |||||||||
| Address1: | 1430 TULANE AVE # SL-37 | ||||||||
| Address2: | MED-PEDS RESIDENCY PROGRAN | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701122632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5049885800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2007 | ||||||||
| LastUpdateDate: | 11/13/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 200587 | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 200587 | LA | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1069931 | 05 | LA | MEDICAID |