Provider Demographics
NPI:1861795569
Name:GERSTLE, JUSTIN THEODORE (MD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:THEODORE
Last Name:GERSTLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 YORK AVE STE H-1315
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6007
Mailing Address - Country:US
Mailing Address - Phone:212-639-7003
Mailing Address - Fax:
Practice Address - Street 1:1275 YORK AVE STE H-1315
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6007
Practice Address - Country:US
Practice Address - Phone:212-639-7003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-19
Last Update Date:2023-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294183-12086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery