Provider Demographics
NPI:1326571217
Name:GORENCHTEIN, MIKE (MB,BS)
Entity Type:Individual
Prefix:DR
First Name:MIKE
Middle Name:
Last Name:GORENCHTEIN
Suffix:
Gender:M
Credentials:MB,BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E 77TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1850
Mailing Address - Country:US
Mailing Address - Phone:212-434-6776
Mailing Address - Fax:212-434-6781
Practice Address - Street 1:178 E 85TH ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-2119
Practice Address - Country:US
Practice Address - Phone:212-434-6776
Practice Address - Fax:212-434-6781
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316892207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine