Provider Demographics
NPI:1659416519
Name:GORNY, TIMOTHY B (MSRD, CDN)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:B
Last Name:GORNY
Suffix:
Gender:M
Credentials:MSRD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 LANGNER RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3307
Mailing Address - Country:US
Mailing Address - Phone:716-870-9246
Mailing Address - Fax:815-308-7648
Practice Address - Street 1:1200 EAST WEST RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3604
Practice Address - Country:US
Practice Address - Phone:716-517-2259
Practice Address - Fax:716-517-3738
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0054171133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered