Provider Demographics
NPI:1275502122
Name:GENDEL, MARINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARINA
Middle Name:
Last Name:GENDEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 E 79TH ST
Mailing Address - Street 2:#1W
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-1037
Mailing Address - Country:US
Mailing Address - Phone:212-988-6966
Mailing Address - Fax:212-628-9400
Practice Address - Street 1:425 E 79TH ST
Practice Address - Street 2:#1W
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-1037
Practice Address - Country:US
Practice Address - Phone:212-988-6966
Practice Address - Fax:212-628-9400
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0389611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice