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General NPI Number Information
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NPI Number | 1245408970
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Entity Type | Organization
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Legal Business Name | JOSE GORIS MD PC
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Dates
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Enumeration Date | 02/15/2008
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Last Update Date | 03/10/2008
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Provider Practice Location Address
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Address Line | 435 FORT WASHINGTON AVENUE #1C
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City | NEW YORK
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State | NY
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Zip | 10033
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Country | US
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Telephone | 212-923-0408
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Fax | 212-923-4032
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Provider Business Mailing Address
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Address Line | 40 PROSPECT STREET
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City | MONROE
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State | NY
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Zip | 10950
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Country | US
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Telephone | 845-238-2168
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Fax | 212-923-4032
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | LUIS BLANCO
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Credential | RPAC
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Telephone | 212-923-0408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 0050751
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License Number State | NY
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