Provider Demographics
NPI:1376588640
Name:RORICK, GREGORY S (DPM)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:S
Last Name:RORICK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 442
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13479-0442
Mailing Address - Country:US
Mailing Address - Phone:315-736-8637
Mailing Address - Fax:315-736-3423
Practice Address - Street 1:587 MAIN ST STE 102B
Practice Address - Street 2:
Practice Address - City:NEW YORK MILLS
Practice Address - State:NY
Practice Address - Zip Code:13417-1490
Practice Address - Country:US
Practice Address - Phone:315-736-8637
Practice Address - Fax:315-736-3423
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006028213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02574550Medicaid
NY02574550Medicaid