Provider Demographics
NPI:1912531575
Name:GURVITSCH, AVROHOM (FNP)
Entity Type:Individual
Prefix:
First Name:AVROHOM
Middle Name:
Last Name:GURVITSCH
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 EASTERN PKWY APT E3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-3413
Mailing Address - Country:US
Mailing Address - Phone:917-783-3986
Mailing Address - Fax:
Practice Address - Street 1:763 EASTERN PKWY APT E3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-3413
Practice Address - Country:US
Practice Address - Phone:917-783-3986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-23
Last Update Date:2020-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345436363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily