MEDICARE: DAVID WAYNE GATELY PHD

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	103TC0700X	Clinical Psychologist	011314	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417958471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID WAYNE GATELY PHD

Provider Business Mailing Address
First Line	:	79 MIDDLEVILLE RD
Second Line	:	VA MEDICAL CENTER, PSYCHOLOGY SERVICE (116B)
City	:	NORTHPORT
State	:	NY
Zip	:	11768-2200
Country	:	US
Telephone Number	:	631-261-4400
Fax Number	:

Provider Business Practice Location Address
First Line	:	79 MIDDLEVILLE RD
Second Line	:	VA MEDICAL CENTER, PSYCHOLOGY SERVICE (116B)
City	:	NORTHPORT
State	:	NY
Zip	:	11768-2200
Country	:	US
Telephone Number	:	631-261-4400
Fax Number	:

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	07/11/2007

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