Healthcare Provider Details

I. General information

NPI: 1093866568
Provider Name (Legal Business Name): MARVIN A GERTZBERG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 ELM ST
COXSACKIE NY
12051-1301
US

IV. Provider business mailing address

7 ELM ST
COXSACKIE NY
12051-1301
US

V. Phone/Fax

Practice location:
  • Phone: 518-731-2797
  • Fax: 518-731-9974
Mailing address:
  • Phone: 518-731-2797
  • Fax: 518-731-9974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number030835-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: