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KENNETH ADAM GERASIMOVICH
NPI 1013654854
Student in an Organized Health Care Education/Training Program in Glen Head, NY

Active since May 13, 2022
11 WILLOW PL, GLEN HEAD, NY 11545(516) 528-0194 Get Directions Write a Review

NPPES record last updated: January 10, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jan 10, 2023, May 13, 2022 (2 updates tracked since 2022).

About Kenneth Adam Gerasimovich NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENNETH ADAM GERASIMOVICH (NPI 1013654854) is an individual student in an organized health care education/training program in Glen Head, New York and active in the NPI registry since May 2022. He maintains a secondary practice location in Oceanside.

NPPES Registry Identity

NPI1013654854
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameKENNETH ADAM GERASIMOVICH
Location Address11 WILLOW PLGlen Head, NY 11545-1561
Mailing Address11 Willow PlGlen Head, NY 11545-1561 · (516) 528-0194
Phone(516) 528-0194
Sole ProprietorNo
Enumeration DateMay 13, 2022
Last NPPES UpdateJanuary 10, 20232 updates tracked since enumeration
NPPES CertifiedJanuary 10, 2023
✔ NPI 1013654854 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
Also ListedPhysician AssistantTaxonomy 363A00000X
11 WILLOW PL, Glen Head, NY 11545
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Secondary Practice Location 1

Location 11 Healthy WayOceanside, NY 11572-1551 · Phone (516) 632-3000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kenneth Gerasimovich's NPI number?

The NPI number for Kenneth Gerasimovich is 1013654854. It was assigned to this individual provider in the NPPES registry on May 13, 2022.

Where is Kenneth Gerasimovich located?

Kenneth Gerasimovich practices at 11 Willow Pl, Glen Head, NY 11545. The listed phone number is (516) 528-0194.

What is Kenneth Gerasimovich's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

When was this NPI record last updated?

The NPPES record for Kenneth Gerasimovich was last updated on January 10, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.