MEDICARE: DR. LAWRENCE GORELICK D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	26956	NY

General Provider Information

NPI Number	:	1225033657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE GORELICK D.D.S.

Provider Business Mailing Address
First Line	:	530 ROUTE 6
Second Line	:
City	:	MAHOPAC
State	:	NY
Zip	:	10541-4746
Country	:	US
Telephone Number	:	845-628-3473
Fax Number	:	845-628-0085

Provider Business Practice Location Address
First Line	:	530 ROUTE 6
Second Line	:
City	:	MAHOPAC
State	:	NY
Zip	:	10541-4746
Country	:	US
Telephone Number	:	845-628-3473
Fax Number	:	845-628-0085

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	07/08/2007

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