Provider Demographics
NPI:1194106187
Name:GEWIRTZ, ANDREW JAY (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JAY
Last Name:GEWIRTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 LAGOON DR E
Mailing Address - Street 2:
Mailing Address - City:LIDO BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4912
Mailing Address - Country:US
Mailing Address - Phone:215-237-1207
Mailing Address - Fax:
Practice Address - Street 1:191 LAGOON DR E
Practice Address - Street 2:
Practice Address - City:LIDO BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-4912
Practice Address - Country:US
Practice Address - Phone:215-237-1207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program