Provider Demographics
NPI:1609184449
Name:GEORGE GORICH, M.D.,P.C.
Entity Type:Organization
Organization Name:GEORGE GORICH, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GORICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-441-8504
Mailing Address - Street 1:9 CAMPUS PL
Mailing Address - Street 2:2B
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-1560
Mailing Address - Country:US
Mailing Address - Phone:914-441-8504
Mailing Address - Fax:914-574-6243
Practice Address - Street 1:672 STONELEIGH AVE
Practice Address - Street 2:C-116
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-4634
Practice Address - Country:US
Practice Address - Phone:914-441-8504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2010-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231731207R00000X, 207RA0401X, 207RB0002X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02630248Medicaid
NYI18213Medicare UPIN
NY037SF1Medicare PIN