Provider Demographics
NPI:1538276415
Name:KERSHIS, FRANK JOHN (PT, COMT)
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:JOHN
Last Name:KERSHIS
Suffix:
Gender:M
Credentials:PT, COMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 ROUTE 112
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-3097
Mailing Address - Country:US
Mailing Address - Phone:631-476-4880
Mailing Address - Fax:631-476-4887
Practice Address - Street 1:1010 ROUTE 112
Practice Address - Street 2:SUITE 200
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-3097
Practice Address - Country:US
Practice Address - Phone:631-476-4880
Practice Address - Fax:631-476-4887
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01570225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY113628992OtherTAX IDENTIFACTION NUMBER
NYQL4281Medicare UPIN