Provider Demographics
NPI:1568709285
Name:W JOSEPH GORUM MD PC
Entity Type:Organization
Organization Name:W JOSEPH GORUM MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:GORUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-577-7442
Mailing Address - Street 1:1503 GRAVESEND NECK RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4428
Mailing Address - Country:US
Mailing Address - Phone:718-479-3303
Mailing Address - Fax:
Practice Address - Street 1:1503 GRAVESEND NECK RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4428
Practice Address - Country:US
Practice Address - Phone:718-479-3303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-15
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty