Healthcare Provider Details

I. General information

NPI: 1942223052
Provider Name (Legal Business Name): DENNIS GERTZER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

667 STONELEIGH AVE SUITE 116
CARMEL NY
10512-2454
US

IV. Provider business mailing address

667 STONELEIGH AVE SUITE 116
CARMEL NY
10512-2454
US

V. Phone/Fax

Practice location:
  • Phone: 845-279-9652
  • Fax: 845-279-3606
Mailing address:
  • Phone: 845-279-9652
  • Fax: 845-279-3606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number101739
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: