Provider Demographics
NPI:1588631816
Name:GORIS, ENID (DPM)
Entity Type:Individual
Prefix:
First Name:ENID
Middle Name:
Last Name:GORIS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 EDISON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-4101
Mailing Address - Country:US
Mailing Address - Phone:718-863-7832
Mailing Address - Fax:718-239-9989
Practice Address - Street 1:1827 EDISON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4101
Practice Address - Country:US
Practice Address - Phone:718-863-7832
Practice Address - Fax:718-239-9989
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-06
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005792213ES0131X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPG 4272OtherPROVIDER ID #
NYPG 4272OtherPROVIDER ID #