Provider Demographics
NPI:1467629600
Name:AMY V GORCZYNSKI RN MD PC
Entity Type:Organization
Organization Name:AMY V GORCZYNSKI RN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:V
Authorized Official - Last Name:GORCZYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-507-4312
Mailing Address - Street 1:1 ELLINWOOD COURT
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13417
Mailing Address - Country:US
Mailing Address - Phone:315-507-4312
Mailing Address - Fax:
Practice Address - Street 1:1 ELLINWOOD CT
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-1100
Practice Address - Country:US
Practice Address - Phone:315-507-4312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212459207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01891737Medicaid