Healthcare Provider Details

I. General information

NPI: 1255485165
Provider Name (Legal Business Name): YULY GERTSBERG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 E 13TH ST STE 1
BROOKLYN NY
11229-1920
US

IV. Provider business mailing address

1720 E 13TH ST STE 1
BROOKLYN NY
11229-1920
US

V. Phone/Fax

Practice location:
  • Phone: 718-998-2929
  • Fax: 718-998-1056
Mailing address:
  • Phone: 718-998-2929
  • Fax: 718-998-1056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number045056
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number045056
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: