Provider Demographics
NPI:1518369297
Name:GORSH, EILEEN MIRASOL (APN)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:MIRASOL
Last Name:GORSH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:BONZON
Other - Last Name:MIRASOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:200 TRENTON ROAD
Mailing Address - Street 2:
Mailing Address - City:BROWNS MILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:08015
Mailing Address - Country:US
Mailing Address - Phone:609-893-1200
Mailing Address - Fax:609-735-2930
Practice Address - Street 1:200 TRENTON ROAD
Practice Address - Street 2:
Practice Address - City:BROWNS MILLS
Practice Address - State:NJ
Practice Address - Zip Code:08015
Practice Address - Country:US
Practice Address - Phone:609-893-1200
Practice Address - Fax:609-735-2930
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00513900363LA2100X
NY430864363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care