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NPI Code Detail

MEDICARE: ALLA GIZERSKAYA DMD

MEDICARE: ALLA GIZERSKAYA DMD
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
11223G0001XGeneral Practice Dentistry056858-1NY

General Provider Information

NPI Number : 1942576434
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALLA GIZERSKAYA DMD
Provider Business Mailing Address
First Line : 976 BARD AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10301-3322
Country : US
Telephone Number : 718-448-1866
Fax Number :
Provider Business Practice Location Address
First Line : 2336 GRAND CONCOURSE
Second Line :
City : BRONX
State : NY
Zip : 10458-6903
Country : US
Telephone Number : 718-220-0439
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2012
Last Update Date : 07/08/2016

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Directions to “ ALLA GIZERSKAYA DMD” Practice Location

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