Healthcare Provider Details

I. General information

NPI: 1942397039
Provider Name (Legal Business Name): GUNNAR KEPPLER GOURAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 E 72ND ST OFC 500
NEW YORK NY
10021-4635
US

IV. Provider business mailing address

520 E 70TH ST # STARR-607
NEW YORK NY
10021-9800
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-2344
  • Fax: 212-746-5584
Mailing address:
  • Phone: 212-746-0373
  • Fax: 212-746-7481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number199780
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: