Individual
GEORGE JORY WIXSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
20 W PARK AVE, SUITE 310B, LONG BEACH, NY 11561-2033
(516) 978-1612
(516) 374-2261
Mailing address
50 W. HAWTHORNE AVE., WOODMERE, NY 11598
(516) 569-6600
(516) 374-2261
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
224685-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02406628
—
NY
Enumeration date
11/29/2006
Last updated
06/28/2013
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