Provider Demographics
NPI:1528591559
Name:GORSKI, HANNAH REBECCA (DMD)
Entity Type:Individual
Prefix:DR
First Name:HANNAH
Middle Name:REBECCA
Last Name:GORSKI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 N BROADWAY
Mailing Address - Street 2:SUITE L1
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2115
Mailing Address - Country:US
Mailing Address - Phone:516-433-1422
Mailing Address - Fax:516-433-7007
Practice Address - Street 1:380 N BROADWAY
Practice Address - Street 2:SUITE L1
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2115
Practice Address - Country:US
Practice Address - Phone:516-433-1422
Practice Address - Fax:516-433-7007
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058242-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist