MEDICARE: DR. JERALD KORMAN M.D.

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	207V00000X	Obstetrics & Gynecology Physician	178057	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912997131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERALD KORMAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 328
Second Line	:
City	:	LAWRENCE
State	:	NY
Zip	:	11559-0328
Country	:	US
Telephone Number	:	416-426-0147
Fax Number	:

Provider Business Practice Location Address
First Line	:	585 SCHENECTADY AVE
Second Line	:	BLOOMBERG BUILDING, SUITE E
City	:	BROOKLYN
State	:	NY
Zip	:	11203-1809
Country	:	US
Telephone Number	:	416-426-0147
Fax Number	:

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

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	09/03/2010

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