Active NPI
Chana Gurvich
- Physician Assistant
- Jackson, NJ
National Provider Identifier
1700350576
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 2290 W County Line Rd
Jackson, NJ 08527-2267 - Phone
- (732) 645-9988
- NPI assigned
- Jan 15, 2019
- Last updated
- Sep 7, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | NU | Primary | |
| Medical Physician Assistant | 363AM0700X | NU |
Addresses
Primary practice location
2290 W County Line Rd
Jackson, NJ 08527-2267
Mailing address
522 Stallion Cir W
Toms River, NJ 08755-1590
Phone (404) 401-7663
Other practice location 1
11203 Queens Blvd
Forest Hills, NY 11375-7473
Phone (718) 263-3718
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Lakewood Medical associates, LLC
- Primary Care Clinic/Center
- Jackson, NJ
- NPI 1851770606
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1547510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694044800000",
"number": "1700350576",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "522 STALLION CIR W",
"city": "TOMS RIVER",
"state": "NJ",
"postal_code": "087551590",
"telephone_number": "404-401-7663"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2290 W COUNTY LINE RD",
"city": "JACKSON",
"state": "NJ",
"postal_code": "085272267",
"telephone_number": "732-645-9988"
}
],
"practiceLocations": [
{
"address_1": "11203 Queens Blvd",
"address_purpose": "LOCATION",
"city": "Forest Hills",
"state": "NY",
"postal_code": "113757473",
"country_code": "US",
"telephone_number": "718-263-3718",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GURVICH",
"first_name": "CHANA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-01-15",
"last_updated": "2023-09-07",
"certification_date": "2023-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.