Individual
ALEXANDER GORBATSEVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
75 N COUNTRY RD, PORT JEFFERSON, NY 11777-2119
(631) 473-1320
(631) 473-1320
Mailing address
625 BELLE TERRE RD, SUITE 100, PORT JEFFERSON, NY 11777-2316
(631) 473-1320
(631) 473-1320
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
240964
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02864955
—
NY
Enumeration date
08/12/2005
Last updated
08/29/2007
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