MEDICARE: GERALD FITERSTEIN DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932713849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERALD FITERSTEIN DDS PC

Provider Business Mailing Address
First Line	:	1049 E 163RD ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10459-4510
Country	:	US
Telephone Number	:	718-842-5020
Fax Number	:

Provider Business Practice Location Address
First Line	:	1049 E 163RD ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10459-4510
Country	:	US
Telephone Number	:	718-842-5020
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GERALD FITERSTEIN
Credential	:	DMD
Telephone Number	:	718-842-5020

Provider Enumeration Date	:	09/08/2020
Last Update Date	:	09/08/2020

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