Organization
EXCELCIUM MED GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSE A GORIS M.D. (PRESIDENT)
(212) 923-0408
Entity
Organization
Contact information
Practice address
435 FT WASHINGTON AVENUE, SUITE 1C, NEW YORK, NY 10033-3527
(212) 923-0408
(212) 923-4032
Mailing address
435 FT WASHINGTON AVENUE, SUITE 1C, NEW YORK, NY 10033-3527
(212) 923-0408
(212) 923-4032
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
190663
NY
208D00000X
General Practice Physician
Primary
190663
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01740610
—
NY
01
—
190663
LICENSE
—
Enumeration date
12/23/2008
Last updated
03/07/2023
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