Provider Demographics
NPI:1730125618
Name:GORICH, GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:GORICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:672 STONELEIGH AVE
Mailing Address - Street 2:STE C116
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-4635
Mailing Address - Country:US
Mailing Address - Phone:845-279-5187
Mailing Address - Fax:845-279-5168
Practice Address - Street 1:672 STONELEIGH AVE
Practice Address - Street 2:STE C116
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-4635
Practice Address - Country:US
Practice Address - Phone:845-279-5187
Practice Address - Fax:845-279-5168
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231731207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02630248Medicaid
NYG64779Medicare UPIN
NYA400066396Medicare PIN
NY037SF1Medicare ID - Type Unspecified