Provider Demographics
NPI:1750370763
Name:GERSTEIN, JAY STEPHEN (DDS)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:STEPHEN
Last Name:GERSTEIN
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 1:8750 BAY PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-5160
Mailing Address - Country:US
Mailing Address - Phone:718-372-2822
Mailing Address - Fax:
Practice Address - Street 1:8750 BAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-5160
Practice Address - Country:US
Practice Address - Phone:718-372-2822
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0311631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY031163OtherSTATE LIC
AG6310849OtherDEA REG NO