Healthcare Provider Details

I. General information

NPI: 1588631816
Provider Name (Legal Business Name): ENID GORIS DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2006
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1827 EDISON AVE
BRONX NY
10461-4101
US

IV. Provider business mailing address

1827 EDISON AVE
BRONX NY
10461-4101
US

V. Phone/Fax

Practice location:
  • Phone: 718-863-7832
  • Fax: 718-239-9989
Mailing address:
  • Phone: 718-863-7832
  • Fax: 718-239-9989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN005792
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberN005792
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: