Provider Demographics
NPI:1790714962
Name:GORIS, JOSE A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:GORIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:435 FORT WASHINGTON AVE
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-3506
Mailing Address - Country:US
Mailing Address - Phone:212-923-0408
Mailing Address - Fax:212-923-4032
Practice Address - Street 1:435 FORT WASHINGTON AVE
Practice Address - Street 2:SUITE 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3506
Practice Address - Country:US
Practice Address - Phone:212-923-0408
Practice Address - Fax:212-923-4032
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY190663207ZP0102X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01740610Medicaid
NYBG3446425OtherDEA
NYBG3446425OtherDEA
NY817681Medicare ID - Type Unspecified