MEDICARE: DR. GARY OWEN GUILFOYLE AU.D.

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	237600000X	Audiologist-Hearing Aid Fitter	1249-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	040426005829	OTHER	NY	FIDELIS
2	10000820	OTHER	NY	CDPHP
3	922068	OTHER	NY	MVP
4	4800227	OTHER	NY	GHI
5	000412015001	OTHER	NY	BLUE SHIELD NENY
6	M03821	OTHER	NY	EMPIRE BC BS

General Provider Information

NPI Number	:	1588645238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY OWEN GUILFOYLE AU.D.

Provider Business Mailing Address
First Line	:	18 PLEASANT ST
Second Line	:
City	:	BALLSTON SPA
State	:	NY
Zip	:	12020-1819
Country	:	US
Telephone Number	:	518-885-0025
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 PLEASANT ST
Second Line	:
City	:	BALLSTON SPA
State	:	NY
Zip	:	12020-1819
Country	:	US
Telephone Number	:	518-885-0025
Fax Number	:

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

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	07/09/2007

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