Provider Demographics
NPI:1053542324
Name:GERZON, IGOR (DDS)
Entity type:Individual
Prefix:DR
First Name:IGOR
Middle Name:
Last Name:GERZON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 MADISON AVENUE
Mailing Address - Street 2:SUITE 1208
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022
Mailing Address - Country:US
Mailing Address - Phone:212-339-8800
Mailing Address - Fax:212-813-1953
Practice Address - Street 1:595 MADISON AVE
Practice Address - Street 2:SUITE 1208
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022
Practice Address - Country:US
Practice Address - Phone:212-339-8800
Practice Address - Fax:212-813-1953
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0408661223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics