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NPI Code Detail

MEDICARE: MARIYA GURVICH O.D.

MEDICARE: MARIYA GURVICH O.D.
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
1152W00000XOptometristTUV008180NY

Other Identifiers

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

General Provider Information

NPI Number : 1689089120
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIYA GURVICH O.D.
Provider Business Mailing Address
First Line : 55 WATER ST
Second Line : 2ND FLOOR CRED DEPT
City : NEW YORK
State : NY
Zip : 10041-0004
Country : US
Telephone Number : 646-680-2888
Fax Number : 516-542-5556
Provider Business Practice Location Address
First Line : 740 64TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11220-4714
Country : US
Telephone Number : 718-439-2000
Fax Number : 718-439-2004
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2014
Last Update Date : 09/12/2019

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