Wixsom, George Jory

Wixsom, George Jory is an individual health care provider with primary practice located at 20 W Park Ave Suite 310B, Long Beach NY 11561-2033. He recently has only one registered license in Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry, which is considered as his primary health care specialty. Wixsom, George Jory can be contacted via phone (516) 978-1612.

Contact Information

Primary practice address
20 W Park Ave Suite 310B Long Beach NY 11561-2033
Phone: (516) 978-1612
Fax: (516) 374-2261
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry 2084P0804X 224685-1 New York

Profile Details

NPI number 1114094612
LBN Legal business name Wixsom, George Jory
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 29th, 2006
Last updated Jun 28th, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114094612 NPPES
New York MEDICAID 02406628

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