MEDICARE: DR. MARK GURTOVY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	200341	NY
2	2084P0800X	Psychiatry Physician	MA 67468	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053332072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK GURTOVY M.D.

Provider Business Mailing Address
First Line	:	7620 BAY PKWY STE 1-B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-1516
Country	:	US
Telephone Number	:	718-232-1492
Fax Number	:	718-232-4505

Provider Business Practice Location Address
First Line	:	7620 BAY PKWY STE 1-B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-1516
Country	:	US
Telephone Number	:	718-232-1492
Fax Number	:	718-232-4505

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	07/19/2010

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