436 GWB Medical Office PC
Organization Active NPI General Practice Physician · New York, NY
NPI 1366952913 · NPPES record last updated Oct 10, 2017
Key facts
- NPI
- 1366952913
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Physician 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
- Organization subpart
- No
Authorized official
- Name
- Jose A Goris, MD
- Title
- MD
- Phone
- (212) 923-0408
Practitioners 2
-
Jose A Goris, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20171102001085 | NY | Part B Supplier - Clinic/Group Practice | 7012273352 |
Receives reassigned benefits from 1 practitioner Practice locations: New York, NY |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | |||
| General Practice Physician |
208D00000X | Yes |
Addresses
Primary practice location
436 Fort Washington Ave Apt 1a
New York, NY 10033-3533
Mailing address
435 Fort Washington Ave Apt 2B
New York, NY 10033-3527
Phone (212) 923-0408
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01740610 | Medicaid | NY |
Other providers in New York, NY
- 42ND Street Dental Associates, LLP
- 42ND Street Dental, Associates
- 42ND Street Physical Medicine & Rehabilitaion,P.C.
- 42ND Street Vision Express, LLC
- 42ND Street Vision Express, LLC
- 43Rd St. Physical Medicine and Rehabilitation, PLLC
- 44 Footcare, P.C.
- 44 Gramercy Gi PLLC
- 44TH Street Chiropractic PC
- 45TH Street Chiropractic
All providers in New York, NY · General Practice Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 10, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.