Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 102145 | NY |
NPI | 1033207964 |
---|---|
Provider Name | Ms. Karen Gorski |
First Address | Gastonia, NC 28054-5530 |
Second Address | Gastonia, NC 28054-5530 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R29578 | (02) | NC |