1609905819 NPI number — G&P GYNECARE PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609905819 NPI number — G&P GYNECARE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
G&P GYNECARE PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609905819
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
306 CENTRAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUNKIRK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14048-2125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-366-4210
Provider Business Mailing Address Fax Number:
716-366-3549

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
306 CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNKIRK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14048-2125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-366-4210
Provider Business Practice Location Address Fax Number:
716-366-3549
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VACANTI
Authorized Official First Name:
GERRY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
716-366-4210

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  151520 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00865247 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0200489 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: Y019094 . This is a "CHAMPUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000081723 . This is a "GHI HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01197002 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9512292 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00500746 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9512254 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0296715 . This is a "GHI PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0703196 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0001013710 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 040426003767 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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