Healthcare Provider Details

I. General information

NPI: 1720647811
Provider Name (Legal Business Name): EVELINE MARIE GUTZWILLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COMMUNITY DR
MANHASSET NY
11030-3876
US

IV. Provider business mailing address

300 COMMUNITY DR
MANHASSET NY
11030-3876
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-6609
  • Fax:
Mailing address:
  • Phone: 212-241-6609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number325780
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: