Provider Demographics
NPI:1417362310
Name:GERARDI, SUZETTE
Entity Type:Individual
Prefix:DR
First Name:SUZETTE
Middle Name:
Last Name:GERARDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3483
Mailing Address - Country:US
Mailing Address - Phone:212-679-7779
Mailing Address - Fax:212-679-8872
Practice Address - Street 1:41 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3483
Practice Address - Country:US
Practice Address - Phone:212-679-7779
Practice Address - Fax:212-679-8872
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047183122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist