Active NPI
Jeffrey S Gorodetsky MD PA
- Legal Medicine
- Stuart, FL
National Provider Identifier
1811186653
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Legal Medicine
- License
- ME0053894
- Legal business name
- JEFFREY S GORODETSKY MD PA
- Practice address
- 433 E Ocean Blvd
Stuart, FL 34994-2573 - Phone
- (772) 223-4504
- Fax
- (772) 223-5988
- NPI assigned
- Oct 17, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Jeffrey S Gorodetsky, MD
- Title
- President
- Phone
- (772) 223-4504
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Legal Medicine | 173000000X | ME0053894 | FL | Primary |
Addresses
Primary practice location
433 E Ocean Blvd
Stuart, FL 34994-2573
Mailing address
433 E Ocean Blvd
Stuart, FL 34994-2573
Phone (772) 223-4504
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 07463 | Other | FL | BLUE CROSS BLUE SHIELD |
| P00307631 | Other | FL | RAILROAD MEDICARE |
| 048745701 | Medicaid | FL | |
| 07463P | Other | FL | MEDICARE INDIVIDUAL |
| K9632 | Other | FL | MEDICACE GROUP |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1192579200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1347840000000",
"number": "1811186653",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "433 E OCEAN BLVD",
"city": "STUART",
"state": "FL",
"postal_code": "349942573",
"telephone_number": "772-223-4504",
"fax_number": "772-223-5988"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "433 E OCEAN BLVD",
"city": "STUART",
"state": "FL",
"postal_code": "349942573",
"telephone_number": "772-223-4504",
"fax_number": "772-223-5988"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "JEFFREY S GORODETSKY MD PA",
"organizational_subpart": "NO",
"enumeration_date": "2007-10-17",
"last_updated": "2012-09-17",
"status": "A",
"authorized_official_last_name": "GORODETSKY",
"authorized_official_first_name": "JEFFREY",
"authorized_official_middle_name": "S",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "772-223-4504",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "173000000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Legal Medicine",
"state": "FL",
"license": "ME0053894",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "07463",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00307631",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "048745701",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE INDIVIDUAL",
"identifier": "07463P",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICACE GROUP",
"identifier": "K9632",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Stuart, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.