Provider Demographics
NPI:1376715607
Name:ENID GORIS, DPM
Entity Type:Organization
Organization Name:ENID GORIS, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ENID
Authorized Official - Middle Name:
Authorized Official - Last Name:GORIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-863-7832
Mailing Address - Street 1:1605 CROSBY AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-5236
Mailing Address - Country:US
Mailing Address - Phone:718-863-7832
Mailing Address - Fax:718-239-9989
Practice Address - Street 1:1605 CROSBY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-5236
Practice Address - Country:US
Practice Address - Phone:718-863-7832
Practice Address - Fax:718-239-9989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005792332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4758440001Medicare NSC