Provider Demographics
NPI:1750465233
Name:GERZON, SEMJOR (DDS)
Entity Type:Individual
Prefix:MR
First Name:SEMJOR
Middle Name:
Last Name:GERZON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65-36 99 STREET
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4358
Mailing Address - Country:US
Mailing Address - Phone:718-897-4278
Mailing Address - Fax:718-886-5328
Practice Address - Street 1:65-36 99 STREET
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4358
Practice Address - Country:US
Practice Address - Phone:718-897-4278
Practice Address - Fax:718-886-5328
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03800211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00799519Medicaid