Provider Demographics
NPI:1417984923
Name:GZESH, DAN JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:JONATHAN
Last Name:GZESH
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 1:1151 OLD YORK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3816
Mailing Address - Country:US
Mailing Address - Phone:215-957-9250
Mailing Address - Fax:215-957-9254
Practice Address - Street 1:1151 OLD YORK RD STE 200
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3816
Practice Address - Country:US
Practice Address - Phone:215-957-9250
Practice Address - Fax:215-957-9254
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037369E2084V0102X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE52790Medicare UPIN
PAE52790Medicare UPIN