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General NPI Number Information
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NPI Number | 1831578871
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Entity Type | Individual
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Provider Name | INGMAR GORMAN PHD
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Gender | Male
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Dates
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Enumeration Date | 05/22/2015
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Last Update Date | 12/27/2024
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Provider Practice Location Address
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Address Line | 370 LEXINGTON AVE
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City | NEW YORK
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State | NY
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Zip | 10017-6503
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Country | US
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Telephone | 929-428-0600
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Fax |
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Provider Business Mailing Address
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Address Line | 39 WILSON AVE # 2F
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City | BROOKLYN
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State | NY
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Zip | 11237-1933
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Country | US
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Telephone | 772-240-8907
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Fax |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 023021
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License Number State | NY
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