Provider Demographics
NPI:1942375654
Name:GORELIK, DMITRY D (MD)
Entity Type:Individual
Prefix:DR
First Name:DMITRY
Middle Name:D
Last Name:GORELIK
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 1:197 WYCKOFF AVE
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-2548
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:197 WYCKOFF AVE
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-2548
Practice Address - Country:US
Practice Address - Phone:646-331-9154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2383000-1207RC0000X, 207RC0000X
NJ25MA09799700207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11780525Medicaid
NY238300OtherNY MEDICAL LICENSE
NYFG1360495OtherDEA
NY238300OtherNY MEDICAL LICENSE
COCOAAA3048Medicare PIN
CA00 A89981 0Medicare ID - Type UnspecifiedMEDICARE