Provider Demographics
NPI:1780004754
Name:GAMZEH, LIRON
Entity Type:Individual
Prefix:
First Name:LIRON
Middle Name:
Last Name:GAMZEH
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 1:1481 E TERRACE CIR
Mailing Address - Street 2:APT #4
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-5217
Mailing Address - Country:US
Mailing Address - Phone:443-928-5322
Mailing Address - Fax:
Practice Address - Street 1:1481 E TERRACE CIR
Practice Address - Street 2:APT #4
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-5217
Practice Address - Country:US
Practice Address - Phone:443-928-5322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program