Provider Demographics
NPI:1407875560
Name:IMBER, GERRY (MD)
Entity Type:Individual
Prefix:DR
First Name:GERRY
Middle Name:
Last Name:IMBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GERALD
Other - Middle Name:
Other - Last Name:IMBER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1009 5TH AVE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0158
Mailing Address - Country:US
Mailing Address - Phone:212-472-1800
Mailing Address - Fax:212-249-2370
Practice Address - Street 1:1009 5TH AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0158
Practice Address - Country:US
Practice Address - Phone:212-472-1800
Practice Address - Fax:212-249-2370
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099229208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY099229OtherNYS LICENSE
NYB14766Medicare UPIN