Provider Demographics
NPI:1730231606
Name:GURVITS, IRENE G (MD)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:G
Last Name:GURVITS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:102 W 75TH ST
Mailing Address - Street 2:107
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-1904
Mailing Address - Country:US
Mailing Address - Phone:212-874-5400
Mailing Address - Fax:212-874-1560
Practice Address - Street 1:102 W 75TH ST
Practice Address - Street 2:107
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-1904
Practice Address - Country:US
Practice Address - Phone:212-874-5400
Practice Address - Fax:212-874-1560
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2082092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG76686Medicare UPIN