=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871977629
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANDREW GEWIRTZ, MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2015
-----------------------------------------------------
Last Update Date | 11/04/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 W 14TH ST STE B
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10011-7501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-792-8192
-----------------------------------------------------
Fax | 516-390-6141
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 W 14TH ST STE B
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10011-7501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-792-8192
-----------------------------------------------------
Fax | 516-390-6141
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MD
-----------------------------------------------------
Name | ANDREW GEWIRTZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 212-792-8192
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 138815-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------