Healthcare Provider Details

I. General information

NPI: 1659366540
Provider Name (Legal Business Name): EPHRIAM M OVITSH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 05/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 20TH ST SUITE 105
NEW YORK NY
10011-3558
US

IV. Provider business mailing address

200 W 20TH ST SUITE 105
NEW YORK NY
10011-3558
US

V. Phone/Fax

Practice location:
  • Phone: 212-647-8560
  • Fax: 212-647-8583
Mailing address:
  • Phone: 212-647-8560
  • Fax: 212-647-8583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number198195
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: