MEDICARE: INTERNAL MEDICINE AND NEPHROLOGY OF NEW YORK, PLLC

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	207R00000X	Internal Medicine Physician	122374	NY
2	207RN0300X	Nephrology Physician	122374	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	:	1942317151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNAL MEDICINE AND NEPHROLOGY OF NEW YORK, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 318
Second Line	:
City	:	NEW ROCHELLE
State	:	NY
Zip	:	10804-0318
Country	:	US
Telephone Number	:	718-881-5100
Fax Number	:	718-881-5700

Provider Business Practice Location Address
First Line	:	3327 BAINBRIDGE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-2801
Country	:	US
Telephone Number	:	718-881-5100
Fax Number	:	718-881-5700

Authorized Official
Title or Position	:	PROPRIETOR
Name	:	DR. JANET U. GORKIN
Credential	:	M.D.
Telephone Number	:	718-881-5100

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	02/14/2011

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