Healthcare Provider Details

I. General information

NPI: 1194106187
Provider Name (Legal Business Name): ANDREW JAY GEWIRTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 MERRICK RD
LYNBROOK NY
11563-2311
US

IV. Provider business mailing address

191 LAGOON DR E
LIDO BEACH NY
11561-4912
US

V. Phone/Fax

Practice location:
  • Phone: 516-764-2273
  • Fax:
Mailing address:
  • Phone: 215-237-1207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number296687
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: