Provider Demographics
NPI:1679081632
Name:GERSTEN, MENACHEM
Entity type:Individual
Prefix:
First Name:MENACHEM
Middle Name:
Last Name:GERSTEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1456 WAKEFIELD CT W
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-3138
Mailing Address - Country:US
Mailing Address - Phone:818-653-8705
Mailing Address - Fax:
Practice Address - Street 1:905 OLD DILEY RD
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-2113
Practice Address - Country:US
Practice Address - Phone:614-864-3222
Practice Address - Fax:614-863-7388
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 390200000X
OHP.08688103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program