Provider Demographics
NPI:1477516615
Name:GEWIRTZ, GEORGE PAUL (MDD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:PAUL
Last Name:GEWIRTZ
Suffix:
Gender:M
Credentials:MDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1632
Mailing Address - Country:US
Mailing Address - Phone:973-335-7124
Mailing Address - Fax:973-322-7251
Practice Address - Street 1:200 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5817
Practice Address - Country:US
Practice Address - Phone:973-322-7200
Practice Address - Fax:973-322-7251
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02725400207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC60350Medicare UPIN