Provider Demographics
NPI:1063692796
Name:EINAUGLER, GERALD (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:EINAUGLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 NEWPORT DRIVE
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1013
Mailing Address - Country:US
Mailing Address - Phone:516-532-3720
Mailing Address - Fax:516-791-6416
Practice Address - Street 1:33 NEWPORT DRIVE
Practice Address - Street 2:
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1013
Practice Address - Country:US
Practice Address - Phone:516-532-3720
Practice Address - Fax:516-791-6416
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129970207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03467OtherMEDICARE GHI
NY00305633Medicaid
NY03467OtherMEDICARE GHI