=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700914256
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GERALD GINSBERG DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1288 VALLEY FORGE RD SUITE 60
-----------------------------------------------------
City | PHOENIXVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19460-2687
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-935-1547
-----------------------------------------------------
Fax | 610-935-7630
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1288 VALLEY FORGE RD SUITE 60
-----------------------------------------------------
City | PHOENIXVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19460-2687
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-935-1547
-----------------------------------------------------
Fax | 610-935-7630
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | DS015109L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------