Provider Demographics
NPI:1528008216
Name:FLORESTAL, GERDA (MD)
Entity Type:Individual
Prefix:DR
First Name:GERDA
Middle Name:
Last Name:FLORESTAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 BRISTOL STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212
Mailing Address - Country:US
Mailing Address - Phone:718-495-7284
Mailing Address - Fax:718-495-7292
Practice Address - Street 1:259 BRISTOL STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212
Practice Address - Country:US
Practice Address - Phone:718-495-7284
Practice Address - Fax:718-495-7292
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204066208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics