Healthcare Provider Details

I. General information

NPI: 1003956764
Provider Name (Legal Business Name): GERALD MARK SWEDER D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 57TH ST SUITE 805
NEW YORK NY
10019-3211
US

IV. Provider business mailing address

200 W 57TH ST SUITE 805
NEW YORK NY
10019-3211
US

V. Phone/Fax

Practice location:
  • Phone: 212-757-2285
  • Fax: 212-757-2286
Mailing address:
  • Phone: 212-757-2285
  • Fax: 212-757-2286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number26659
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: