Provider Demographics
NPI:1730122458
Name:REMISOVSKY, GEORGE ANTON (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ANTON
Last Name:REMISOVSKY
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:PO BOX 3386
Mailing Address - Street 2:1174 YELLOWSTONE DRIVE
Mailing Address - City:LAKE ARROWHEAD
Mailing Address - State:CA
Mailing Address - Zip Code:92352-3386
Mailing Address - Country:US
Mailing Address - Phone:909-336-3778
Mailing Address - Fax:909-336-0507
Practice Address - Street 1:29101 HOSPITAL RD.
Practice Address - Street 2:SUITE 114
Practice Address - City:LAKE ARROWHEAD
Practice Address - State:CA
Practice Address - Zip Code:92352-1570
Practice Address - Country:US
Practice Address - Phone:909-336-3778
Practice Address - Fax:909-336-0507
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52138207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2962918Medicaid
NJ2962918Medicaid
NJRE653562Medicare ID - Type Unspecified