Provider Demographics
NPI:1518133131
Name:GOURGEY, CHARLES (PHD, MT-BC, LCAT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:GOURGEY
Suffix:
Gender:M
Credentials:PHD, MT-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 W 14TH ST
Mailing Address - Street 2:#4A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7407
Mailing Address - Country:US
Mailing Address - Phone:212-675-9493
Mailing Address - Fax:
Practice Address - Street 1:55 W 14TH ST
Practice Address - Street 2:#4A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7407
Practice Address - Country:US
Practice Address - Phone:212-675-9493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-04
Last Update Date:2008-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000182225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist