Provider Demographics
NPI:1184007437
Name:GEWIRTZ, NECHAMA (MA)
Entity Type:Individual
Prefix:
First Name:NECHAMA
Middle Name:
Last Name:GEWIRTZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15015 79TH AVE
Mailing Address - Street 2:APT. 5H
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3945
Mailing Address - Country:US
Mailing Address - Phone:845-664-1781
Mailing Address - Fax:
Practice Address - Street 1:15015 79TH AVE
Practice Address - Street 2:APT. 5H
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3945
Practice Address - Country:US
Practice Address - Phone:845-664-1781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-06
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1901339174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist