Provider Demographics
NPI:1669114054
Name:GUREVITZ, MENACHEM MENDEL (DO)
Entity type:Individual
Prefix:
First Name:MENACHEM
Middle Name:MENDEL
Last Name:GUREVITZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7306 BROOKHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-2205
Mailing Address - Country:US
Mailing Address - Phone:718-663-9868
Mailing Address - Fax:
Practice Address - Street 1:7306 BROOKHAVEN RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-2205
Practice Address - Country:US
Practice Address - Phone:718-663-9868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS023002208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice