Healthcare Provider Details

I. General information

NPI: 1922213628
Provider Name (Legal Business Name): DR. GERALD P. ELOVITZ, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 SANTUIT-NEWTOWN RD
COTUIT MA
02635-2509
US

IV. Provider business mailing address

1860 SANTUIT-NEWTOWN RD
COTUIT MA
02635-2509
US

V. Phone/Fax

Practice location:
  • Phone: 508-420-9989
  • Fax:
Mailing address:
  • Phone: 508-420-9989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number2591
License Number StateMA

VIII. Authorized Official

Name: DR. GERALD PAUL ELOVITZ
Title or Position: CLINICAL NEUROPSYCHOLOGIST
Credential: D.ED.
Phone: 508-420-9989