Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 247141-1 | NY |
N | 111NI0900X | Internist | 247141-1 | NY |
Y | 207RI0200X | Infectious Disease | 247141 | NY |
NPI | 1023273380 |
---|---|
Provider Name | Gerald Abraham Ancheta |
First Address | Nyack, NY 10960-1627 |
Second Address | Nyack, NY 10960-1627 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2008 |
Last Update Date | 22/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03132643 | (05) | NY |
A300027192 | MEDICARE PTAN (01) | NY |