Provider Demographics
NPI:1144365925
Name:SCHATZBERG, GARY L (DMD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
Last Name:SCHATZBERG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2159
Mailing Address - Country:US
Mailing Address - Phone:917-670-2882
Mailing Address - Fax:
Practice Address - Street 1:19 HAMILTON PLACE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-6885
Practice Address - Country:US
Practice Address - Phone:212-234-4800
Practice Address - Fax:212-234-4302
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0483951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02043158Medicaid