Healthcare Provider Details

I. General information

NPI: 1578862454
Provider Name (Legal Business Name): MIRIAM GEWIRTZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2011
Last Update Date: 03/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 CAREY ST
LAKEWOOD NJ
08701-1918
US

IV. Provider business mailing address

43 CAREY ST
LAKEWOOD NJ
08701-1918
US

V. Phone/Fax

Practice location:
  • Phone: 732-598-1504
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number44SL05629900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: