Provider Demographics
NPI:1780613612
Name:GORACY, ALICJA H (MD)
Entity type:Individual
Prefix:
First Name:ALICJA
Middle Name:H
Last Name:GORACY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:156 CHESTNUT STREET
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632
Mailing Address - Country:US
Mailing Address - Phone:718-245-1565
Mailing Address - Fax:718-245-1565
Practice Address - Street 1:451 CLARKSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2054
Practice Address - Country:US
Practice Address - Phone:718-245-1565
Practice Address - Fax:718-245-1565
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1927182085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01692593Medicaid
NJMA643319OtherLICENSE
NJMA643319OtherLICENSE
NY01692593Medicaid