Provider Demographics
NPI:1942216700
Name:MASSACHE, GORKY F (DC)
Entity Type:Individual
Prefix:DR
First Name:GORKY
Middle Name:F
Last Name:MASSACHE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 NEW ROAD
Mailing Address - Street 2:BLDG C SUITE 3A
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054
Mailing Address - Country:US
Mailing Address - Phone:973-808-8660
Mailing Address - Fax:973-808-1468
Practice Address - Street 1:239 NEW ROAD
Practice Address - Street 2:SUITE C302
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054
Practice Address - Country:US
Practice Address - Phone:973-808-8660
Practice Address - Fax:973-808-1468
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0093051111N00000X
NJ38MD00556400111N00000X
NY4119111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
U79172Medicare UPIN
035801Medicare PIN