Organization · NPI-2

436 Gwb Medical Office PC

General Practice · New York, NY

NPI number1366952913
StatusActive
Last updated in NPPESOct 10, 2017

Details

NPI
1366952913
Entity type
Organization (NPI-2)
Legal business name
436 Gwb Medical Office PC
Organization subpart
No
Enumeration date
Oct 10, 2017
Last updated
Oct 10, 2017

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
208D00000X General Practice––Yes
207R00000X Internal Medicine––

Practice location

436 Fort Washington Ave Apt 1a
New York, NY 10033-3533

Phone 212-923-0408 · Fax 212-923-7051

Mailing address

435 Fort Washington Ave Apt 2b
New York, NY 10033-3527

Phone 212-923-0408 · Fax 212-923-7051

Authorized official

Jose A Goris
MD
2129230408

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