Provider Demographics
NPI:1649338740
Name:GREGORY S RORICK
Entity type:Organization
Organization Name:GREGORY S RORICK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:RORICK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:315-736-8637
Mailing Address - Street 1:PO BOX 442
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13479-0442
Mailing Address - Country:US
Mailing Address - Phone:315-736-8637
Mailing Address - Fax:
Practice Address - Street 1:587 MAIN ST
Practice Address - Street 2:SUITE 102 B
Practice Address - City:NEW YORK MILLS
Practice Address - State:NY
Practice Address - Zip Code:13417-1481
Practice Address - Country:US
Practice Address - Phone:315-736-8637
Practice Address - Fax:315-736-3423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006028213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03079967Medicaid
NY5779230001Medicare NSC