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General NPI Number Information
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NPI Number | 1619996774
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Entity Type | Individual
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Provider Name | GARY I GORODOKIN MD
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Gender | Male
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 03/15/2011
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Provider Practice Location Address
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Address Line | 24-07 A BROADWAY
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City | FAIR LAWN
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State | NJ
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Zip | 07410
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Country | US
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Telephone | 201-791-7760
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Fax | 201-791-7746
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Provider Business Mailing Address
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Address Line | 34 KNIGHTS COURT
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City | UPPER SADDLE RIVER
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State | NJ
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Zip | 07458
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Country | US
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Telephone | 201-791-7760
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Fax | 201-791-7746
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MA06159800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 182511
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License Number State | NY
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