1558595769 NPI number — DR. GIRSHOVICH MEDICAL CARE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558595769 NPI number — DR. GIRSHOVICH MEDICAL CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. GIRSHOVICH MEDICAL CARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558595769
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
810 ABBOTT BLVD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
FORT LEE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07024-4151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-886-9699
Provider Business Mailing Address Fax Number:
201-886-9015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
810 ABBOTT BLVD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
FORT LEE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07024-4151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-886-9699
Provider Business Practice Location Address Fax Number:
201-886-9015
Provider Enumeration Date:
05/04/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GIRSHOVICH
Authorized Official First Name:
IRINA
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
201-886-9699

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MA62306 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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