MEDICARE: IRENE G GURVITS, MD, PC

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	207R00000X	Internal Medicine Physician	208209	NY
2	2084B0002X	Obesity Medicine (Psychiatry & Neurology) Physician
3	2084P0802X	Addiction Psychiatry Physician
4	2084P0800X	Psychiatry Physician	208209	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598071995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRENE G GURVITS, MD, PC

Provider Business Mailing Address
First Line	:	102 W 75TH ST
Second Line	:	SUITE 107
City	:	NEW YORK
State	:	NY
Zip	:	10023-1904
Country	:	US
Telephone Number	:	212-874-5400
Fax Number	:	212-874-1560

Provider Business Practice Location Address
First Line	:	102 W 75TH ST
Second Line	:	SUITE 107
City	:	NEW YORK
State	:	NY
Zip	:	10023-1904
Country	:	US
Telephone Number	:	212-874-5400
Fax Number	:	212-874-1560

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. IRENE G GURVITS
Credential	:	M.D.
Telephone Number	:	212-874-5400

Provider Enumeration Date	:	08/23/2010
Last Update Date	:	08/23/2010

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