1922213628 NPI number — DR. GERALD P. ELOVITZ, P.C.

Table of content: (NPI 1922213628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922213628 NPI number — DR. GERALD P. ELOVITZ, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. GERALD P. ELOVITZ, P.C.
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:
THE MEMORY CENTER
Provider Other Organization Name Type Code:
3
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:
1922213628
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1860 SANTUIT-NEWTOWN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COTUIT
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02635-2509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-420-9989
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1860 SANTUIT-NEWTOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COTUIT
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02635-2509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-420-9989
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ELOVITZ
Authorized Official First Name:
GERALD
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
CLINICAL NEUROPSYCHOLOGIST
Authorized Official Telephone Number:
508-420-9989

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X , with the licence number:  2591 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9784624 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: W10408 . This is a "PC BCBS GROUP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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