Basic Information
| Provider Information | |||||||||
| NPI: | 1871567925 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GERDIS | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2422 CENTRAL PARK AVE | ||||||||
| Address2: | |||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107101125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147792995 | ||||||||
| FaxNumber: | 9147793266 | ||||||||
| Practice Location | |||||||||
| Address1: | 2422 CENTRAL PARK AVE | ||||||||
| Address2: | |||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147792995 | ||||||||
| FaxNumber: | 9147793266 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 09/25/2019 | ||||||||
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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 | 185309 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | 185309 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 01465407 | 05 | NY | MEDICAID |