Provider Demographics
NPI:1376602201
Name:GORSKI, LYDIA ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:ELIZABETH
Last Name:GORSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4514
Mailing Address - Country:US
Mailing Address - Phone:516-352-0430
Mailing Address - Fax:516-437-4567
Practice Address - Street 1:820 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4514
Practice Address - Country:US
Practice Address - Phone:516-352-0430
Practice Address - Fax:516-437-4567
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167846207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA64578Medicare UPIN
NYA400005493Medicare PIN