Provider Demographics
NPI:1366758724
Name:KERGE, MAROL (PMHNP)
Entity type:Individual
Prefix:
First Name:MAROL
Middle Name:
Last Name:KERGE
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 MADISON AVE., SUITE 1501
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-203-1773
Mailing Address - Fax:646-665-4427
Practice Address - Street 1:274 MADISON AVE., SUITE 1501
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-203-1773
Practice Address - Fax:646-665-4427
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN48572163W00000X
NY833406-01163W00000X
RIAPRN01516363LP0808X, 364SP0808X
RICAPRN01516364SP0808X
NYF403911-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health