Provider Demographics
NPI:1992989271
Name:GERSHON, ROGER M (DDS)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:M
Last Name:GERSHON
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 1:871 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-4953
Mailing Address - Country:US
Mailing Address - Phone:212-249-9523
Mailing Address - Fax:212-650-9599
Practice Address - Street 1:871 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4953
Practice Address - Country:US
Practice Address - Phone:212-249-9523
Practice Address - Fax:212-650-9599
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-22
Last Update Date:2007-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0290581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice