Healthcare Provider Details

I. General information

NPI: 1851448591
Provider Name (Legal Business Name): RON GORNIE L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14732 JAMAICA AVE
JAMAICA NY
11435-4042
US

IV. Provider business mailing address

54 JOYCE RD
PLAINVIEW NY
11803-3912
US

V. Phone/Fax

Practice location:
  • Phone: 718-526-8400
  • Fax:
Mailing address:
  • Phone: 516-938-5396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR028145-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: