Provider Demographics
NPI:1194844274
Name:ZACHARY E. GERUT M D F A C S P C
Entity Type:Organization
Organization Name:ZACHARY E. GERUT M D F A C S P C
Other - Org Name:DR. GERUT'S AESTHETIC SURGERY OPERATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GERUT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-295-2100
Mailing Address - Street 1:11999 SAN VICENTE BLVD
Mailing Address - Street 2:STE. 440
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-5131
Mailing Address - Country:US
Mailing Address - Phone:310-471-5852
Mailing Address - Fax:310-471-3958
Practice Address - Street 1:1245 COLONIAL RD
Practice Address - Street 2:
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-2006
Practice Address - Country:US
Practice Address - Phone:516-295-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical