Provider Demographics
NPI:1568583185
Name:GORMAN , JR., JAMES (CTRS)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:GORMAN , JR.
Suffix:
Gender:M
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 POINT VIEW DR
Mailing Address - Street 2:
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-1813
Mailing Address - Country:US
Mailing Address - Phone:518-451-9685
Mailing Address - Fax:
Practice Address - Street 1:64 2ND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12202-1240
Practice Address - Country:US
Practice Address - Phone:518-449-5170
Practice Address - Fax:518-598-0493
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14386225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist