Healthcare Provider Details

I. General information

NPI: 1841216371
Provider Name (Legal Business Name): MONICA DENISSE HURVITZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 03/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E 109TH ST APT 5B
NEW YORK NY
10029-3771
US

IV. Provider business mailing address

333 E 109TH ST APT 5B
NEW YORK NY
10029-3771
US

V. Phone/Fax

Practice location:
  • Phone: 318-572-6519
  • Fax:
Mailing address:
  • Phone: 318-572-6519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number248605
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: