MEDICARE: AVIVA GEWIRTZ

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	225XP0200X	Pediatric Occupational Therapist		NY
2	225X00000X	Occupational Therapist		NY

General Provider Information

NPI Number	:	1811681919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVIVA GEWIRTZ

Provider Business Mailing Address
First Line	:	7728 VLEIGH PL APT F
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11367-3145
Country	:	US
Telephone Number	:	347-712-0282
Fax Number	:

Provider Business Practice Location Address
First Line	:	7728 VLEIGH PL APT F
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11367-3145
Country	:	US
Telephone Number	:	347-712-0282
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2023
Last Update Date	:	06/05/2023

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Directions to “ AVIVA GEWIRTZ ” Practice Location

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