Healthcare Provider Details

I. General information

NPI: 1740253186
Provider Name (Legal Business Name): HARVEY D GORRIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MOORE AVE
MT KISCO NY
10549
US

IV. Provider business mailing address

15 MOORE AVE
MT KISCO NY
10549
US

V. Phone/Fax

Practice location:
  • Phone: 914-666-6448
  • Fax: 914-242-3718
Mailing address:
  • Phone: 914-666-6448
  • Fax: 914-242-3718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number113205
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: