Provider Demographics
NPI:1023303229
Name:PSYCHIATRY&PSYCHOSOMATIC MEDICINE
Entity type:Organization
Organization Name:PSYCHIATRY&PSYCHOSOMATIC MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORMUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-464-7599
Mailing Address - Street 1:549 PINES LAKE DR E
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5117
Mailing Address - Country:US
Mailing Address - Phone:973-464-7599
Mailing Address - Fax:
Practice Address - Street 1:549 PINES LAKE DR E
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-5117
Practice Address - Country:US
Practice Address - Phone:973-464-7599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25 MA08664800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty