Provider Demographics
NPI:1922213628
Name:DR. GERALD P. ELOVITZ, P.C.
Entity Type:Organization
Organization Name:DR. GERALD P. ELOVITZ, P.C.
Other - Org Name:THE MEMORY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:ELOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DED
Authorized Official - Phone:508-420-9989
Mailing Address - Street 1:1860 SANTUIT-NEWTOWN RD
Mailing Address - Street 2:
Mailing Address - City:COTUIT
Mailing Address - State:MA
Mailing Address - Zip Code:02635-2509
Mailing Address - Country:US
Mailing Address - Phone:508-420-9989
Mailing Address - Fax:
Practice Address - Street 1:1860 SANTUIT-NEWTOWN RD
Practice Address - Street 2:
Practice Address - City:COTUIT
Practice Address - State:MA
Practice Address - Zip Code:02635-2509
Practice Address - Country:US
Practice Address - Phone:508-420-9989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2591103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9784624Medicaid
MAW10408OtherPC BCBS GROUP
MAW10408OtherPC BCBS GROUP