Provider Demographics
NPI:1174882625
Name:WINTHROP GERIATRIC MEDICINE ASSOCIATES PC
Entity type:Organization
Organization Name:WINTHROP GERIATRIC MEDICINE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRVING
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-663-2588
Mailing Address - Street 1:222 STATION PLZ N
Mailing Address - Street 2:SUITE 518
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3800
Mailing Address - Country:US
Mailing Address - Phone:516-663-2588
Mailing Address - Fax:516-663-4644
Practice Address - Street 1:222 STATION PLZ N
Practice Address - Street 2:SUITE 518
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3800
Practice Address - Country:US
Practice Address - Phone:516-663-2588
Practice Address - Fax:516-663-4644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty