Provider Demographics
NPI:1619285145
Name:GREGORY L. GORSKI, A PROFESSIONAL MEDICAL CORP
Entity Type:Organization
Organization Name:GREGORY L. GORSKI, A PROFESSIONAL MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MADELEINE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:GORSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-799-6025
Mailing Address - Street 1:834 MILAN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-2813
Mailing Address - Country:US
Mailing Address - Phone:626-799-6025
Mailing Address - Fax:626-399-0314
Practice Address - Street 1:933 S SUNSET AVE
Practice Address - Street 2:105
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3410
Practice Address - Country:US
Practice Address - Phone:626-338-9000
Practice Address - Fax:626-338-9022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG159772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty