Individual provider Active NPI

Kimberly Loring Gershon, M.S.CCC-SLP

  • Speech-Language Pathologist
  • Woodbury, NY
National Provider Identifier
1063669299
Registry record updated Aug 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
012673 Issued in NY
Practice address
118 Woody LN
Woodbury, NY 11797-3014
Phone
(516) 458-6063
NPI assigned
Aug 19, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 19, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 012673 NY Primary

Addresses

Primary practice location

118 Woody LN
Woodbury, NY 11797-3014

Mailing address

118 Woody LN
Woodbury, NY 11797-3014
Phone (516) 458-6063

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
012673NYMDSpeech-Language Pathologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219104000000",
    "number": "1063669299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 WOODY LN",
            "city": "WOODBURY",
            "state": "NY",
            "postal_code": "117973014",
            "telephone_number": "516-458-6063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 WOODY LN",
            "city": "WOODBURY",
            "state": "NY",
            "postal_code": "117973014",
            "telephone_number": "516-458-6063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GERSHON",
        "first_name": "KIMBERLY",
        "middle_name": "LORING",
        "name_prefix": "Mrs.",
        "credential": "M.S.CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-08-19",
        "last_updated": "2008-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "012673",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbury, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.