Provider Demographics
NPI:1740314889
Name:GORALSKY, JACK (PSYD)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:
Last Name:GORALSKY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 OLD DOVER RD
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-1120
Mailing Address - Country:US
Mailing Address - Phone:973-285-5523
Mailing Address - Fax:973-285-0584
Practice Address - Street 1:546 OLD DOVER RD
Practice Address - Street 2:
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950-1120
Practice Address - Country:US
Practice Address - Phone:973-285-5523
Practice Address - Fax:973-285-0584
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100125800103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical