Provider Demographics
NPI:1932309150
Name:MITCHELL M GERTZ
Entity Type:Organization
Organization Name:MITCHELL M GERTZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:GERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:617-387-6118
Mailing Address - Street 1:906 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-3126
Mailing Address - Country:US
Mailing Address - Phone:617-387-6118
Mailing Address - Fax:617-387-6118
Practice Address - Street 1:906 BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-3126
Practice Address - Country:US
Practice Address - Phone:617-387-6118
Practice Address - Fax:617-387-6118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1699213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY77097Medicare PIN