Healthcare Provider Details

I. General information

NPI: 1235210667
Provider Name (Legal Business Name): JUDITH E GURLAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL ARTS PAVILION 3400 BAINBRIDGE AVENUE
BRONX NY
10467
US

IV. Provider business mailing address

3117 PALISADE AVE
BRONX NY
10463-1013
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-2020
  • Fax:
Mailing address:
  • Phone: 718-920-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number105255
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number105255
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: