Healthcare Provider Details

I. General information

NPI: 1194450312
Provider Name (Legal Business Name): KRISTIN GEBAUER-WIRTZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 07/21/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 SUMNER PL
BROOKLYN NY
11206-4110
US

IV. Provider business mailing address

16 SUMNER PL
BROOKLYN NY
11206-4110
US

V. Phone/Fax

Practice location:
  • Phone: 718-336-9500
  • Fax:
Mailing address:
  • Phone: 347-982-6425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number315170
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: