Healthcare Provider Details

I. General information

NPI: 1700949773
Provider Name (Legal Business Name): THERESA ANN GORINO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 06/15/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2316 DELAWARE AVENUE PMB 258
BUFFALO NY
14216-2606
US

IV. Provider business mailing address

2316 DELAWARE AVE
BUFFALO NY
14216-2606
US

V. Phone/Fax

Practice location:
  • Phone: 585-236-9336
  • Fax:
Mailing address:
  • Phone: 585-236-9336
  • Fax: 585-271-7948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number453962-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: