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General NPI Number Information
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NPI Number | 1053311340
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Entity Type | Individual
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Provider Name | LAUREN KANTOR GORMAN MD
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Gender | Female
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 685 W END AVE SUITE A1F
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City | NEW YORK
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State | NY
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Zip | 10025-6819
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Country | US
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Telephone | 212-580-7713
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Fax | 718-548-0568
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Provider Business Mailing Address
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Address Line | 685 W END AVE SUITE 1AF
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City | NEW YORK
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State | NY
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Zip | 10025-6819
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Country | US
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Telephone | 212-580-7713
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Fax | 718-548-0568
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 134719
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License Number State | NY
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