Healthcare Provider Details

I. General information

NPI: 1609184449
Provider Name (Legal Business Name): GEORGE GORICH, M.D.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 09/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

672 STONELEIGH AVE C-116
CARMEL NY
10512-4634
US

IV. Provider business mailing address

9 CAMPUS PL 2B
SCARSDALE NY
10583-1560
US

V. Phone/Fax

Practice location:
  • Phone: 914-441-8504
  • Fax:
Mailing address:
  • Phone: 914-441-8504
  • Fax: 914-574-6243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number231731
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number231731
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number231731
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number231731
License Number StateNY

VIII. Authorized Official

Name: GEORGE GORICH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 914-441-8504