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NPI Code Detail

MEDICARE: GUSTAVE S. DRIVAS MD. PC.

MEDICARE: GUSTAVE S. DRIVAS MD. PC.
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
1207R00000XInternal Medicine Physician186334NY
2207LP2900XPain Medicine (Anesthesiology) Physician186334NY

Other Identifiers

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

General Provider Information

NPI Number : 1477756377
Entity Type Code : Organization
Provider Name (Legal Business Name) : GUSTAVE S. DRIVAS MD. PC.
Provider Business Mailing Address
First Line : 3377 RICHMOND AVE
Second Line : BASEMENT
City : STATEN ISLAND
State : NY
Zip : 10312-2025
Country : US
Telephone Number : 718-948-3890
Fax Number : 718-948-3961
Provider Business Practice Location Address
First Line : 3377 RICHMOND AVE
Second Line : BASEMENT
City : STATEN ISLAND
State : NY
Zip : 10312-2025
Country : US
Telephone Number : 718-948-3890
Fax Number : 718-948-3961
Authorized Official
Title or Position : PRESIDENT
Name : DR. GUSTAVE STEPHEN DRIVAS
Credential : MD
Telephone Number : 718-948-3890
Provider Enumeration Date : 06/07/2007
Last Update Date : 02/25/2008

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