Gologor, Ethan

Gologor, Ethan is an sole proprietor health care provider with primary practice located at 340 E. 93 St 21E, New York NY 10128-5555. He recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Exercise & Sports, Behavioral Health & Social Service Providers / Psychologist. Behavioral Health & Social Service Providers / Psychologist is his primary health care specialty. Gologor, Ethan can be contacted via phone (212) 737-0072.

Contact Information

Primary practice address
340 E. 93 St 21E New York NY 10128-5555
Phone: (212) 737-0072
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 004698 New York
Behavioral Health & Social Service Providers / Exercise & Sports 103TE1100X 004698 New York
Behavioral Health & Social Service Providers / Psychologist 103T00000X 004698 New York

Profile Details

NPI number 1790825503
LBN Legal business name Gologor, Ethan
Credentials PH.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 8th, 2007
Last updated Mar 1st, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790825503 NPPES
New York Other 146126 VALUE OPTIONS
New York Other 61033707 VALUE OPTIONS
New York MEDICAID 00921811 VALUE OPTIONS
New York Other 0099997 VALUE OPTIONS
New York Other 176973 VALUE OPTIONS

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