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General NPI Number Information
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NPI Number | 1649551391
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Entity Type | Individual
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Provider Name | JADE R GORMADY O.D.
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Gender | Female
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Dates
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Enumeration Date | 09/07/2011
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Last Update Date | 05/07/2012
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Provider Practice Location Address
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Address Line | 128 FT WASHINGTN AVE APT J
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City | NEW YORK
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State | NY
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Zip | 10032-4735
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Country | US
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Telephone | 212-928-9590
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Fax | 212-569-9100
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Provider Business Mailing Address
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Address Line | 128 FT WASHINGTN AVE APT J
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City | NEW YORK
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State | NY
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Zip | 10032-4735
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Country | US
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Telephone | 212-928-9590
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Fax | 212-569-9100
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV007705
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License Number State | NY
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