Provider Demographics
NPI:1477673077
Name:JOSE A GORIS, MD PC
Entity Type:Organization
Organization Name:JOSE A GORIS, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GORIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-923-0408
Mailing Address - Street 1:435 FORT WASHINGTON AVE
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-3506
Mailing Address - Country:US
Mailing Address - Phone:212-923-0408
Mailing Address - Fax:212-740-5163
Practice Address - Street 1:435 FORT WASHINGTON AVE
Practice Address - Street 2:SUITE 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3506
Practice Address - Country:US
Practice Address - Phone:212-923-0408
Practice Address - Fax:212-740-5163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190663208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01740610Medicaid
NY01740610Medicaid
NY01740610Medicaid
NY817681Medicare ID - Type UnspecifiedMEDICARE ID