Provider Demographics
NPI:1053332072
Name:GURTOVY, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:GURTOVY
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 1:7620 BAY PKWY STE 1-B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-1516
Mailing Address - Country:US
Mailing Address - Phone:718-232-1492
Mailing Address - Fax:718-232-4505
Practice Address - Street 1:7620 BAY PKWY STE 1-B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-1516
Practice Address - Country:US
Practice Address - Phone:718-232-1492
Practice Address - Fax:718-232-4505
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2003412084P0800X
NJMA 674682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01740601Medicaid
NJ8364605Medicaid
NYG43093Medicare UPIN
NY051M0520Medicare ID - Type Unspecified
NJ038007Medicare ID - Type Unspecified