Provider Demographics
NPI:1306874979
Name:GACHETTE, EMMANUEL AMILCAR (MD)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:AMILCAR
Last Name:GACHETTE
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 1:473 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07501-2862
Mailing Address - Country:US
Mailing Address - Phone:973-707-8243
Mailing Address - Fax:
Practice Address - Street 1:473 MAIN ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-2862
Practice Address - Country:US
Practice Address - Phone:973-707-8243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237620-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI49464Medicare UPIN
NY5626D1Medicare ID - Type Unspecified