Provider Demographics
NPI:1487038576
Name:SHIGOL, GOR (OD)
Entity Type:Individual
Prefix:
First Name:GOR
Middle Name:
Last Name:SHIGOL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646-2308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:873 SAINT GEORGES AVE
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095
Practice Address - Country:US
Practice Address - Phone:732-750-3900
Practice Address - Fax:732-750-4869
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008308152W00000X
NJ27OA00661900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist