Provider Demographics
NPI:1760559728
Name:PETER G. GORMAN DCPC
Entity Type:Organization
Organization Name:PETER G. GORMAN DCPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-628-4900
Mailing Address - Street 1:PO BOX 873
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-0873
Mailing Address - Country:US
Mailing Address - Phone:845-628-4900
Mailing Address - Fax:
Practice Address - Street 1:11 MILLER RD
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-2219
Practice Address - Country:US
Practice Address - Phone:845-628-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0002504.1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC02504.1OtherNYS WORKERS COMPENSATION
NYX14151Medicare ID - Type Unspecified