Organization
GATEWAY PHYSICIAN GROUP PLLC
Active
Organization
GATEWAY PHYSICIAN GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL GODDARD (ADMINISTRATOR)
(718) 858-3263
Entity
Organization
Contact information
Practice address
186 JORALEMON ST, 8TH FLOOR, BROOKLYN, NY 11201-4326
(718) 858-3263
Mailing address
186 JORALEMON ST, 8TH FLOOR, BROOKLYN, NY 11201-4326
(718) 858-3263
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
185657
NY
208100000X
Physical Medicine & Rehabilitation Physician
222545
NY
208VP0014X
Interventional Pain Medicine Physician
Primary
096783
NY
208VP0014X
Interventional Pain Medicine Physician
239276
NY
Other
Enumeration date
08/14/2009
Last updated
08/14/2009
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