Healthcare Provider Details

I. General information

NPI: 1861329831
Provider Name (Legal Business Name): MIGENA GORA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 AVENUE Z STE 304
BROOKLYN NY
11235-3084
US

IV. Provider business mailing address

121 CRYSTAL AVE
STATEN ISLAND NY
10302-2526
US

V. Phone/Fax

Practice location:
  • Phone: 347-921-3250
  • Fax:
Mailing address:
  • Phone: 646-283-8176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2542730
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: