Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 237927 | NY |
NPI | 1144528050 |
---|---|
Provider Name | Dr. Jerrold Conrad Gendler |
First Address | Great Neck, NY 11021 |
Second Address | Great Neck, NY 11021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2011 |
Last Update Date | 02/03/2011 |