Provider Demographics
NPI:1679893945
Name:ERIC B. GEWOLB M.D., P.A.
Entity Type:Organization
Organization Name:ERIC B. GEWOLB M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ER
Authorized Official - Middle Name:
Authorized Official - Last Name:GEWOLB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-339-0200
Mailing Address - Street 1:830 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-5834
Mailing Address - Country:US
Mailing Address - Phone:201-339-0200
Mailing Address - Fax:201-339-0201
Practice Address - Street 1:830 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-5834
Practice Address - Country:US
Practice Address - Phone:201-339-0200
Practice Address - Fax:201-339-0201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA034464002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty