GEORGE JORY WIXSOM (NPI# 1114094612) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114094612 |
| Entity Type | Individual |
| Full Name | GEORGE JORY WIXSOM |
| Credential | MD |
| Practice Address |
20 W Park Ave Suite 310b Long Beach NY 11561-2033 |
| Mailing Address |
50 W. Hawthorne Ave. Woodmere NY 11598 |
| Practice Telephone | 5169781612 |
| Practice Fax Number | 5163742261 |
| Mailing Telephone | 5165696600 |
| Mailing Fax Number | 5163742261 |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2013-06-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
224685-1 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 02406628 | 05 |
| Street Address |
20 W PARK AVE SUITE 310B |
| City | LONG BEACH |
| State | NY |
| Zip Code | 11561-2033 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083246961 | Romina Zitofsky | Community Health Worker | 65 Pacific Blvd, Long Beach, NY 11561 | 2020-02-07 |
| 1710519038 | Can Flei Corp. | Massage Therapist | 116 Taft Ave., Long Beach, NY 11561 | 2020-02-05 |
| 1073032199 | Sherrie Cooper | Behavior Technician | 554 East Pine Street, Long Beach, NY 11561 | 2017-09-11 |
| 1437679354 | Alana Doonachar | Physician Assistant | 100 Belmont Avenue, Long Beach, NY 11561 | 2017-06-21 |
| 1023547452 | Tina Bayer | Nurse Practitioner | 427 East Chester Street 2nd Floor, Long Beach, NY 11561 | 2017-06-08 |
| 1316483977 | Taylor Nicole Paganini | Massage Therapist | 252 Grand Blvd, Long Beach, NY 11561 | 2017-01-06 |
| 1265803688 | Stop and Shop Supermarket Co LLC | Durable Medical Equipment & Medical Supplies | 85 East Park Ave, Long Beach, NY 11561 | 2015-10-12 |
| 1588048797 | Carol Bell | Behavioral Analyst | 121 Harding Avenue, Long Beach, NY 11561 | 2015-07-17 |
| 1811378821 | Patricia Harris | Case Manager/Care Coordinator | 72 Illinios Avenue, Long Beach, NY 11561 | 2015-06-16 |
| 1164801916 | Antonia Dileo | Marriage & Family Therapist | 36 Prescott Street, Lido Beach, NY 11561 | 2015-05-27 |
| Find all providers in zip 11561 | ||||
| Taxonomy Code | 2084P0804X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Child & Adolescent Psychiatry |
| Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407827769 | Mohan Nair | Psychiatry & Neurology | 133 The Promenade N Ste 108, Long Beach, CA 90802-4728 | 2006-01-26 |
| 1770181257 | Allyson Wells Md Inc | Psychiatry & Neurology | 5150 E Pacific Coast Hwy Ste 100, Long Beach, CA 90804-3394 | 2020-10-15 |
| 1720304785 | Monica Soliman | Psychiatry & Neurology | 1301 Pine Ave, Long Beach, CA 90813-3124 | 2010-04-15 |
| 1265567606 | Todd Franklin Bolinger | Psychiatry & Neurology | 3711 Long Beach Blvd, Suite 600, Long Beach, CA 90807-3315 | 2007-02-23 |
| 1376619221 | Farhad Khorrami Yaghoubi | Psychiatry & Neurology | 2600 Redondo Ave Fl 6, Long Beach, CA 90806-2325 | 2006-11-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093327611 | Adel Mostafavi, Md PC | Psychiatry & Neurology | 104 W 40th St Rm 400, New York, NY 10018-3692 | 2020-08-17 |
| 1023632015 | Child and Adult Clinical Psychiatry PC | Psychiatry & Neurology | 75 Prospect St Ste 110, Huntington, NY 11743-3320 | 2020-06-04 |
| 1598306441 | Place of Mind Child, Adolescent, and Adult Psychiatry P.C. | Psychiatry & Neurology | 240 Central Park S Apt 2h, New York, NY 10019-1435 | 2019-10-02 |
| 1881102267 | Park Avenue Physicians PC | Psychiatry & Neurology | 5 W 86th St Apt 1b, New York, NY 10024-3663 | 2018-01-19 |
| 1518478080 | Diego G. Calabria Physician P.C. | Psychiatry & Neurology | 366 N Broadway Ste 304, Jericho, NY 11753-2000 | 2017-10-23 |
| 1013426865 | Bebsy Estefan Md PC | Psychiatry & Neurology | 3050 Corlear Ave # Phb, Bronx, NY 10463-5180 | 2017-09-25 |
| 1902281629 | Derek Rudge | Psychiatry & Neurology | 1051 Riverside Dr Rm 235, New York, NY 10032-1007 | 2015-07-23 |
| 1275918096 | Dr Omar Bashayan Physician Pllc | Psychiatry & Neurology | 155 W 68th St Apt 1102, New York, NY 10023-5816 | 2015-07-22 |
| 1740676766 | Maura E Tappen | Psychiatry & Neurology | 1860 South Ave, Rochester, NY 14620-4229 | 2015-04-07 |
| 1194119560 | Krishen Persaud | Psychiatry & Neurology | Stony Brook Psychiatric Associates, Ufpc, Sbumc, Hsc Level 10, Rm.020, Stony Brook, NY 11794-8101 | 2015-03-24 |
| Find all providers with the same taxonomy | ||||
| City | LONG BEACH |
| Zip Code | 11561 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.