Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | N005792 | NY |
N | 213ES0131X | Foot Surgery | N005792 | NY |
NPI | 1588631816 |
---|---|
Provider Name | Enid Goris |
First Address | Bronx, NY 10461-4101 |
Second Address | Bronx, NY 10461-4101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2006 |
Last Update Date | 14/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PG 4272 | PROVIDER ID # (01) | NY |
U86076 | (02) | NY |