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General NPI Number Information
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NPI Number | 1689165102
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Entity Type | Individual
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Provider Name | ANDREW MARTIN BERGER GERSHON DDS
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Gender | Male
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Dates
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Enumeration Date | 05/21/2018
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Last Update Date | 06/03/2022
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Provider Practice Location Address
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Address Line | 871 5TH AVENUE SUITE 1C
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City | NEW YORK
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State | NY
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Zip | 10065
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Country | US
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Telephone | 212-249-9523
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Fax |
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Provider Business Mailing Address
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Address Line | 27 E 13TH ST APT 2F
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City | NEW YORK
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State | NY
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Zip | 10003-4456
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Country | US
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Telephone | 646-704-4240
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 060595
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License Number State | NY
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