Individual
EDWARD GORMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
160 PINTAIL LN APT 203, DAVENPORT, FL 33896-7070
(516) 912-3822
Mailing address
160 PINTAIL LN APT 203, DAVENPORT, FL 33896-7070
(516) 912-3822
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
TRANSPORTATION COMPANY
—
Enumeration date
09/11/2019
Last updated
07/13/2026
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