Basic Information
| Provider Information | |||||||||
| NPI: | 1538128608 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GERSHON | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | STEINER | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 40 HART ST | ||||||||
| Address2: | |||||||||
| City: | NEW BRITAIN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060521743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602292059 | ||||||||
| FaxNumber: | 8602298495 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 ARCH RD. | ||||||||
| Address2: | |||||||||
| City: | AVON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060014202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606731955 | ||||||||
| FaxNumber: | 8602718025 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2006 | ||||||||
| LastUpdateDate: | 07/11/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 35846 | CT | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 010035846CT21 | 01 | CT | ANTHEM BC/BS | OTHER | 300109311 | 01 | CT | RAILROAD MEDICARE | OTHER | 300117739 | 01 | CT | RAILROAD MEDICARE | OTHER | 001358466 | 05 | CT | MEDICAID | 010035846CT19 | 01 | CT | ANTHEM BC/BS | OTHER | 010035846CT22 | 01 | CT | ANTHEM BC/BS | OTHER | 1538128608 | 05 | CT | MEDICAID | 010035846CT16 | 01 | CT | ANTHEM BC/BS | OTHER | 300117752 | 01 | CT | RAILROAD MEDICARE | OTHER | 010035846CT17 | 01 | CT | ANTHEM BC/BS | OTHER | 010035846CT23 | 01 | CT | ANTHEM BC/BS | OTHER | 300117747 | 01 | CT | RAILROAD MEDICARE | OTHER | 300117768 | 01 | CT | RAILROAD MEDICARE | OTHER |