Provider Demographics
NPI:1407002041
Name:B DAVID GORMAN MD PC
Entity Type:Organization
Organization Name:B DAVID GORMAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:B DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-517-4500
Mailing Address - Street 1:1115 5TH AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-0100
Mailing Address - Country:US
Mailing Address - Phone:212-517-4500
Mailing Address - Fax:212-517-4116
Practice Address - Street 1:1115 5TH AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-0100
Practice Address - Country:US
Practice Address - Phone:212-517-4500
Practice Address - Fax:212-517-4116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00385039Medicaid
NY11A061Medicare PIN
NY00385039Medicaid