Provider Demographics
NPI:1790851251
Name:GORKIN, BRETT DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:DAVID
Last Name:GORKIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 W 56TH ST
Mailing Address - Street 2:1F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3764
Mailing Address - Country:US
Mailing Address - Phone:212-765-7961
Mailing Address - Fax:
Practice Address - Street 1:333 W 56TH ST
Practice Address - Street 2:1F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3764
Practice Address - Country:US
Practice Address - Phone:212-765-7961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2015-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6146103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV27222Medicare ID - Type UnspecifiedPROVIDER NUMBER SECOND OF
NYV27221Medicare ID - Type UnspecifiedPROVIDER NUMBER
NYR52097Medicare UPIN