Provider Demographics
NPI:1144833062
Name:DJOUKA, GERTRUDE S (MD)
Entity type:Individual
Prefix:MISS
First Name:GERTRUDE
Middle Name:S
Last Name:DJOUKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6136 170TH ST
Mailing Address - Street 2:APT M4
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1957
Mailing Address - Country:US
Mailing Address - Phone:734-355-1281
Mailing Address - Fax:
Practice Address - Street 1:6136 170TH ST APT M4
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-1957
Practice Address - Country:US
Practice Address - Phone:347-709-3133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-29
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program