Healthcare Provider Details

I. General information

NPI: 1699773010
Provider Name (Legal Business Name): MICHAEL I GUREVICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/10/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

997 GLEN COVE AVE
GLEN HEAD NY
11545-1593
US

IV. Provider business mailing address

997 GLEN COVE AVE
GLEN HEAD NY
11545-1593
US

V. Phone/Fax

Practice location:
  • Phone: 516-674-9489
  • Fax: 516-759-5946
Mailing address:
  • Phone: 516-674-9489
  • Fax: 516-759-5946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number170878
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number170878
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: