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General NPI Number Information
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NPI Number | 1447465125
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Entity Type | Individual
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Provider Name | GAYLE SUZANNE GOREN M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 635 W 165TH ST 4TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10032-3724
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Country | US
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Telephone | 212-305-9835
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Fax | 212-305-9732
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Provider Business Mailing Address
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Address Line | 276 W 119TH ST APT. 5D
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City | NEW YORK
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State | NY
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Zip | 10026-1113
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Country | US
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Telephone | 917-673-6269
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Fax | 212-305-9732
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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 | 2084P0015X
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Taxonomy Name | Psychosomatic Medicine Physician
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License Number | 225161
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License Number State | NY
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