Provider Demographics
NPI:1700879087
Name:GORMAN, JACK M (MD)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:M
Last Name:GORMAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2700 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463
Mailing Address - Country:US
Mailing Address - Phone:718-601-2927
Mailing Address - Fax:212-860-3945
Practice Address - Street 1:1425 MADISON AVE
Practice Address - Street 2:BOX 1230
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-659-8763
Practice Address - Fax:212-860-3945
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1347002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry