MEDICARE: AKIVA GORNISH PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	253-073	NJ

General Provider Information

NPI Number	:	1215800297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AKIVA GORNISH PSYD

Provider Business Mailing Address
First Line	:	1000D LAKE ST
Second Line	:
City	:	RAMSEY
State	:	NJ
Zip	:	07446-1295
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000D LAKE ST
Second Line	:
City	:	RAMSEY
State	:	NJ
Zip	:	07446-1295
Country	:	US
Telephone Number	:	845-600-4089
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2025
Last Update Date	:	09/25/2025

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Directions to “ AKIVA GORNISH PSYD” Practice Location

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