Provider Demographics
NPI:1861598104
Name:GORING, MALCOLM VIBART (MD)
Entity type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:VIBART
Last Name:GORING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MALCOLM
Other - Middle Name:VIBART
Other - Last Name:GORING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:161-7 CLARKSON AVE
Mailing Address - Street 2:APT. 1A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226
Mailing Address - Country:US
Mailing Address - Phone:718-282-6619
Mailing Address - Fax:
Practice Address - Street 1:100 NORTH PORTLAND AVE.
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205
Practice Address - Country:US
Practice Address - Phone:718-260-7812
Practice Address - Fax:718-260-7711
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health