Provider Demographics
NPI:1457344459
Name:DEPUEY, ERNEST GORDON III (MD)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:GORDON
Last Name:DEPUEY
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 GUSTAVE L. LEVY PLACE
Mailing Address - Street 2:BOX 1194
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6574
Mailing Address - Country:US
Mailing Address - Phone:212-241-8395
Mailing Address - Fax:212-289-0092
Practice Address - Street 1:1780 BROADWAY
Practice Address - Street 2:7TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1414
Practice Address - Country:US
Practice Address - Phone:211-315-0144
Practice Address - Fax:212-315-0196
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2015-01-07
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Provider Licenses
StateLicense IDTaxonomies
NY178463-1207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY40F44Medicare ID - Type Unspecified
NYE01030Medicare UPIN
NY01184803Medicaid