Excelcium Med Group, PC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

190663 Issued in NY

Legal business name

EXCELCIUM MED GROUP, PC

Practice address

435 Ft Washington Avenue
Suite 1C
New York, NY 10033-3527

Phone

(212) 923-0408

Fax

(212) 923-4032

NPI assigned

Dec 23, 2008

Last updated

Mar 7, 2023By 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, M.D.NPI 1790714962

Title

President

Phone

(212) 923-0408

Specialties & licenses 2

Addresses

Other identifiers 2

Practitioners 1

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

  Anatomic Pathology & Clinical Pathology

  NPD (past) Authorized official

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

{
    "created_epoch": "1229990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1902042815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "435 FT WASHINGTON AVENUE",
            "address_2": "SUITE 1C",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100333527",
            "telephone_number": "212-923-0408",
            "fax_number": "212-923-4032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 FT WASHINGTON AVENUE",
            "address_2": "SUITE 1C",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100333527",
            "telephone_number": "212-923-0408",
            "fax_number": "212-923-4032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCELCIUM MED GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-23",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "GORIS",
        "authorized_official_first_name": "JOSE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "212-923-0408",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NY",
            "license": "190663",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "NY",
            "license": "190663",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01740610",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "190663",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tamara Ewoldt, P.T.
• Julie Ewy, CPNP
• Wilsa Exantus, LCSW
• Maria V Exarchakis, MS, CCC-SLP, TSSLD,
• Theresa Exavier, CRNA
• Excella Medicine PC
• Excella Medicine PC
• Excelsior Empirehealth Ipa, LLC
• Excelsior Integrated Medical Group
• Excelsior Integrated Medical Group, PLLC

• 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 Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.