MEDICARE: MR. GARY FRANKLIN ROHRS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	3416621	NY

General Provider Information

NPI Number	:	1093982522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY FRANKLIN ROHRS RN

Provider Business Mailing Address
First Line	:	BOX 520
Second Line	:	72 POCAHONTAS TRAIL
City	:	SMALLWOOD
State	:	NY
Zip	:	12778-0520
Country	:	US
Telephone Number	:	845-796-6974
Fax Number	:	845-292-8235

Provider Business Practice Location Address
First Line	:	60 SUNSET LAKE ROAD
Second Line	:	SULLIVAN COUNTY ADULT CARE CENTER
City	:	LIBERTY
State	:	NY
Zip	:	12754-0000
Country	:	US
Telephone Number	:	845-292-8640
Fax Number	:	845-292-8235

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	05/14/2008

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