Provider Demographics
NPI:1154405652
Name:GERGELY PEDIATRICS PC
Entity type:Organization
Organization Name:GERGELY PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MGR SECRETARY OF CORP
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GERGELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-424-4444
Mailing Address - Street 1:34 ROUTE 403
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10524
Mailing Address - Country:US
Mailing Address - Phone:845-424-4444
Mailing Address - Fax:845-424-4664
Practice Address - Street 1:34 ROUTE 403
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:NY
Practice Address - Zip Code:10524
Practice Address - Country:US
Practice Address - Phone:845-424-4444
Practice Address - Fax:845-424-4664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160282208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01147979Medicaid
Q00051Medicare UPIN