Provider Demographics
NPI:1598737637
Name:AMATUCCI, GERALD (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:AMATUCCI
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 1:4 FULLER ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA BAY
Mailing Address - State:NY
Mailing Address - Zip Code:13607-1316
Mailing Address - Country:US
Mailing Address - Phone:315-482-1111
Mailing Address - Fax:315-482-4981
Practice Address - Street 1:4 FULLER ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA BAY
Practice Address - State:NY
Practice Address - Zip Code:13607-1316
Practice Address - Country:US
Practice Address - Phone:315-482-1111
Practice Address - Fax:315-482-4981
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174009207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA1719Medicare PIN
NYB83050Medicare UPIN
NYRB0386Medicare PIN