Basic Information
Provider Information | |||||||||
NPI: | 1821364019 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GORSHEIN | ||||||||
FirstName: | ELAN | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO, JD, MPH | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | YALE-NEW HAVEN SHORELINE MEDICAL CENTER | ||||||||
Address2: | 111 GOOSE LANE, SUITE 1300 | ||||||||
City: | GUILFORD | ||||||||
State: | CT | ||||||||
PostalCode: | 06437 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2034539192 | ||||||||
FaxNumber: | 2034530875 | ||||||||
Practice Location | |||||||||
Address1: | YALE-NEW HAVEN SHORELINE MEDICAL CENTER | ||||||||
Address2: | 111 GOOSE LANE, SUITE 1300 | ||||||||
City: | GUILFORD | ||||||||
State: | CT | ||||||||
PostalCode: | 06437 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2034539192 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/01/2012 | ||||||||
LastUpdateDate: | 03/02/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/02/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0000X | 60343 | CT | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology | 207RX0202X | 60343 | CT | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 390200000X |   |   | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 207RH0003X | 60343 | CT | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.