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General NPI Number Information
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NPI Number | 1487195913
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Entity Type | Organization
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Legal Business Name | JONATHAN H GORMAN DDS LLC
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Dates
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Enumeration Date | 03/16/2017
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Last Update Date | 03/16/2017
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Provider Practice Location Address
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Address Line | 984 N BROADWAY SUITE 504
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City | YONKERS
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State | NY
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Zip | 10701-1318
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Country | US
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Telephone | 914-963-1460
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Fax |
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Provider Business Mailing Address
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Address Line | 984 N BROADWAY SUITE 504
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City | YONKERS
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State | NY
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Zip | 10701-1318
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. JONATHAN GORMAN
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Credential | DDS
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Telephone | 914-963-1460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 054502
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License Number State | NY
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