Healthcare Provider Details

I. General information

NPI: 1164171815
Provider Name (Legal Business Name): BARUCH GUBNITSKY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 CYPRESS AVE
BROOKLYN NY
11224-1306
US

IV. Provider business mailing address

3840 CYPRESS AVE
BROOKLYN NY
11224-1306
US

V. Phone/Fax

Practice location:
  • Phone: 347-768-2803
  • Fax:
Mailing address:
  • Phone: 718-375-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100330-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: