MEDICARE: JAMES P. GURTOWSKI, M.D., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	163559	NY

General Provider Information

NPI Number	:	1225321029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES P. GURTOWSKI, M.D., P.C.

Provider Business Mailing Address
First Line	:	110 E MAIN ST
Second Line	:	SUITE 7
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-2845
Country	:	US
Telephone Number	:	631-673-5255
Fax Number	:	631-673-4949

Provider Business Practice Location Address
First Line	:	110 E MAIN ST
Second Line	:	SUITE 7
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-2845
Country	:	US
Telephone Number	:	631-673-5255
Fax Number	:	631-673-4949

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES PATRICK GURTOWSKI
Credential	:	M.D.
Telephone Number	:	631-673-5255

Provider Enumeration Date	:	05/26/2011
Last Update Date	:	06/03/2011

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