Provider Demographics
NPI:1659704211
Name:GEROV, DIANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:GEROV
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 1:150-28 SUITE 100
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-4240
Mailing Address - Country:US
Mailing Address - Phone:718-591-3444
Mailing Address - Fax:
Practice Address - Street 1:1300 UNION TPKE STE 106
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1760
Practice Address - Country:US
Practice Address - Phone:516-354-7551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-17
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056884122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist