Healthcare Provider Details

I. General information

NPI: 1669550851
Provider Name (Legal Business Name): HAROLD S GEWIRTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 MILL RIVER STREET
STAMFORD CT
06902
US

IV. Provider business mailing address

70 MILL RIVER STREET
STAMFORD CT
06902
US

V. Phone/Fax

Practice location:
  • Phone: 203-325-1381
  • Fax: 203-975-5286
Mailing address:
  • Phone: 203-325-1381
  • Fax: 203-975-5286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number023598
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number023598
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: