436 GWB Medical Office PC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

436 GWB MEDICAL OFFICE PC

Practice address

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

Phone

(212) 923-0408

Fax

(212) 923-7051

NPI assigned

Oct 10, 2017

Last updated

Oct 10, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jose A Goris, MDNPI 1790714962

Title

MD

Phone

(212) 923-0408

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jose A Goris, M.D.

  • General Practice Physician
  • New York, NY
  • NPI 1790714962
  Medicare reassignment Authorized official
• Rivel Lozada

  • Health Educator
  • New York, NY
  • NPI 1235748732
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1507593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507593600000",
    "number": "1366952913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "435 FORT WASHINGTON AVE APT 2B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100333527",
            "telephone_number": "212-923-0408",
            "fax_number": "212-923-7051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "436 FORT WASHINGTON AVE APT 1A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100333533",
            "telephone_number": "212-923-0408",
            "fax_number": "212-923-7051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "436 GWB MEDICAL OFFICE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-10",
        "last_updated": "2017-10-10",
        "status": "A",
        "authorized_official_last_name": "GORIS",
        "authorized_official_first_name": "JOSE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "212-923-0408",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 42ND Street Dental Associates, LLP
• 42ND Street Dental, Associates
• 42ND Street Physical Medicine & Rehabilitaion,P.C.
• 42ND Street Vision Express, LLC (cohen's fashion optical)
• 42ND Street Vision Express, LLC (General Vision Services)
• 43Rd St. Physical Medicine and Rehabilitation, PLLC
• 44 Footcare, P.C.
• 44 Gramercy Gi PLLC
• 44TH Street Chiropractic PC
• 45TH Street Chiropractic

• General Practice Physician in New York, NY
• Providers in New York, NY by specialty
• General Practice Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.