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General NPI Number Information
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NPI Number | 1902042815
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Entity Type | Organization
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Legal Business Name | EXCELCIUM MED GROUP, PC
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Dates
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Enumeration Date | 12/23/2008
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 435 FT WASHINGTON AVENUE SUITE 1C
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City | NEW YORK
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State | NY
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Zip | 10033-3527
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Country | US
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Telephone | 212-923-0408
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Fax | 212-923-4032
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Provider Business Mailing Address
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Address Line | 435 FT WASHINGTON AVENUE SUITE 1C
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City | NEW YORK
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State | NY
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Zip | 10033-3527
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Country | US
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Telephone | 212-923-0408
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Fax | 212-923-4032
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSE A GORIS
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Credential | M.D.
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Telephone | 212-923-0408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 190663
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 190663
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License Number State | NY
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