Provider Demographics
NPI:1265551444
Name:GORGA, JULIO SR (MD)
Entity type:Individual
Prefix:DR
First Name:JULIO
Middle Name:
Last Name:GORGA
Suffix:SR
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:PO BOX 451
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-0451
Mailing Address - Country:US
Mailing Address - Phone:914-384-2577
Mailing Address - Fax:718-334-6719
Practice Address - Street 1:9542 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-8012
Practice Address - Country:US
Practice Address - Phone:718-334-6720
Practice Address - Fax:718-334-6719
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193140208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics