1477673077 NPI number — JOSE A GORIS, MD PC

Table of content: (NPI 1477673077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477673077 NPI number — JOSE A GORIS, MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSE A GORIS, MD PC
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:
Provider Other Organization Name Type Code:
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:
1477673077
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
435 FORT WASHINGTON AVE
Provider Second Line Business Mailing Address:
SUITE 1C
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10033-3506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-923-0408
Provider Business Mailing Address Fax Number:
212-740-5163

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
435 FORT WASHINGTON AVE
Provider Second Line Business Practice Location Address:
SUITE 1C
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10033-3506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-923-0408
Provider Business Practice Location Address Fax Number:
212-740-5163
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GORIS
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
212-923-0408

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  190663 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01740610 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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