Provider Demographics
NPI:1710755038
Name:GEWIRTZ, DOV
Entity Type:Individual
Prefix:
First Name:DOV
Middle Name:
Last Name:GEWIRTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 AYCRIGG AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4704
Mailing Address - Country:US
Mailing Address - Phone:973-473-1498
Mailing Address - Fax:
Practice Address - Street 1:228 AYCRIGG AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4704
Practice Address - Country:US
Practice Address - Phone:973-473-1498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program