Individual
DR. BENCLEMENT GERVACIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3722 82ND ST, JACKSON HEIGHTS, NY 11372-7040
(718) 932-1000
Mailing address
2339 27TH ST, ASTORIA, NY 11105-3109
(718) 879-1600
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
276622
NY
207RI0200X
Infectious Disease Physician
276622
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
276622
MEDICAL LICENSE
NY
Enumeration date
04/29/2011
Last updated
01/28/2025
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