Provider Demographics
NPI:1831268101
Name:MCGORK, JAMES J III (RPAC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:MCGORK
Suffix:III
Gender:M
Credentials:RPAC
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 304
Mailing Address - Street 2:ADIRONACK MEDICAL SERVICES
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-0304
Mailing Address - Country:US
Mailing Address - Phone:518-926-6992
Mailing Address - Fax:518-926-6983
Practice Address - Street 1:100 PARK ST
Practice Address - Street 2:GLENS FALLS HOSPITAL
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4413
Practice Address - Country:US
Practice Address - Phone:518-926-6992
Practice Address - Fax:518-926-6983
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006715-1363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02167733Medicaid
S79468Medicare UPIN
NYAA0798Medicare PIN
NY02167733Medicaid
NYJ400232183Medicare PIN