Provider Demographics
NPI:1326223231
Name:LITZKY, GERALD M (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:M
Last Name:LITZKY
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 1:3 KENSINGTON CT
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2872
Mailing Address - Country:US
Mailing Address - Phone:201-568-5303
Mailing Address - Fax:
Practice Address - Street 1:3 KENSINGTON CT
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2872
Practice Address - Country:US
Practice Address - Phone:201-568-5303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA18657174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE13167Medicare UPIN