Provider Demographics
NPI:1558595769
Name:DR. GIRSHOVICH MEDICAL CARE, INC.
Entity Type:Organization
Organization Name:DR. GIRSHOVICH MEDICAL CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRSHOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-886-9699
Mailing Address - Street 1:810 ABBOTT BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-4151
Mailing Address - Country:US
Mailing Address - Phone:201-886-9699
Mailing Address - Fax:201-886-9015
Practice Address - Street 1:810 ABBOTT BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-4151
Practice Address - Country:US
Practice Address - Phone:201-886-9699
Practice Address - Fax:201-886-9015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-04
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA62306207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG19637Medicare UPIN