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General NPI Number Information
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NPI Number | 1679893945
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Entity Type | Organization
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Legal Business Name | ERIC B. GEWOLB M.D., P.A.
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Dates
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Enumeration Date | 06/09/2010
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Last Update Date | 06/09/2010
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Provider Practice Location Address
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Address Line | 830 KENNEDY BLVD
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City | BAYONNE
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State | NJ
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Zip | 07002-5834
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Country | US
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Telephone | 201-339-0200
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Fax | 201-339-0201
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Provider Business Mailing Address
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Address Line | 830 KENNEDY BLVD
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City | BAYONNE
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State | NJ
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Zip | 07002-5834
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Country | US
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Telephone | 201-339-0200
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Fax | 201-339-0201
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Authorized Official
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Title or Position | PSYCHIATRIST/PRESIDENT
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Name | DR. ER GEWOLB
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Credential | M.D.
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Telephone | 201-339-0200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25MA03446400
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License Number State | NJ
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