Provider Demographics
NPI:1396720769
Name:GEWIRTZ, JEFFREY (DPM)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:GEWIRTZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 PASCACK RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PARK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07656-1935
Mailing Address - Country:US
Mailing Address - Phone:201-391-1113
Mailing Address - Fax:
Practice Address - Street 1:74 PASCACK RD
Practice Address - Street 2:SUITE 6
Practice Address - City:PARK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07656-1935
Practice Address - Country:US
Practice Address - Phone:201-391-1113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006024213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02569175Medicaid
U99408Medicare UPIN
NYPJ2862Medicare ID - Type Unspecified
NJ5617770001Medicare NSC
NY02569175Medicaid