Healthcare Provider Details

I. General information

NPI: 1396720769
Provider Name (Legal Business Name): JEFFREY GEWIRTZ DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 02/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 PASCACK RD SUITE 6
PARK RIDGE NJ
07656-1935
US

IV. Provider business mailing address

74 PASCACK RD SUITE 6
PARK RIDGE NJ
07656-1935
US

V. Phone/Fax

Practice location:
  • Phone: 201-391-1113
  • Fax:
Mailing address:
  • Phone: 201-391-1113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN006024
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: