Provider Demographics
NPI:1982601191
Name:GEWIRTZ, ANDREW E (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:E
Last Name:GEWIRTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 E 20TH ST
Mailing Address - Street 2:4H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-1302
Mailing Address - Country:US
Mailing Address - Phone:212-792-8192
Mailing Address - Fax:212-253-8002
Practice Address - Street 1:524 E 20TH ST
Practice Address - Street 2:4H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-1302
Practice Address - Country:US
Practice Address - Phone:212-995-8458
Practice Address - Fax:212-253-8002
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY138815207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00829552Medicaid
NY17D932Medicare ID - Type Unspecified
NY00829552Medicaid