Provider Demographics
NPI:1750606349
Name:GOROVOY, IAN (MD)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:GOROVOY
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 1:2371 BLACK ROCK TPKE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-3229
Mailing Address - Country:US
Mailing Address - Phone:203-371-0141
Mailing Address - Fax:203-371-6585
Practice Address - Street 1:2371 BLACK ROCK TPKE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-3229
Practice Address - Country:US
Practice Address - Phone:203-371-0141
Practice Address - Fax:203-371-6585
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT55411207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008067004Medicaid
CTD400316291Medicare PIN