Provider Demographics
NPI:1952431587
Name:GERTSBERG, YAKOV (DDS)
Entity Type:Individual
Prefix:MR
First Name:YAKOV
Middle Name:
Last Name:GERTSBERG
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 1:561 EAST 3 STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-4505
Mailing Address - Country:US
Mailing Address - Phone:718-854-3031
Mailing Address - Fax:718-854-3031
Practice Address - Street 1:561 E 3RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-5064
Practice Address - Country:US
Practice Address - Phone:718-854-3031
Practice Address - Fax:718-854-3031
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0451221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01470942Medicaid