Provider Demographics
NPI:1992948707
Name:GUTNICK, JESSE REED (MD)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:REED
Last Name:GUTNICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18101 LORAIN AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5612
Mailing Address - Country:US
Mailing Address - Phone:267-471-8747
Mailing Address - Fax:
Practice Address - Street 1:4900 BORAD RD
Practice Address - Street 2:SUITE 23 NORTH
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215
Practice Address - Country:US
Practice Address - Phone:315-492-5036
Practice Address - Fax:315-492-5477
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288644208600000X
NC2015-02325208600000X
OH57.016192208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery