Healthcare Provider Details

I. General information

NPI: 1508155201
Provider Name (Legal Business Name): DINA M GAGE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 JEFFERSON HTS SUITE D107
CATSKILL NY
12414-1237
US

IV. Provider business mailing address

159 JEFFERSON HTS SUITE D107
CATSKILL NY
12414-1237
US

V. Phone/Fax

Practice location:
  • Phone: 518-943-1442
  • Fax: 518-943-2003
Mailing address:
  • Phone: 518-943-1442
  • Fax: 518-943-2003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF336626-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: