Healthcare Provider Details

I. General information

NPI: 1578655890
Provider Name (Legal Business Name): ELLIOT J. GURSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 NASSAU ST
PRINCETON NJ
08542-4519
US

IV. Provider business mailing address

92 NASSAU ST
PRINCETON NJ
08542-4519
US

V. Phone/Fax

Practice location:
  • Phone: 609-924-6294
  • Fax: 609-924-6352
Mailing address:
  • Phone: 609-924-6294
  • Fax: 609-924-6352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number25MA02856400
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: