Healthcare Provider Details

I. General information

NPI: 1528380912
Provider Name (Legal Business Name): GARY MICHAEL DEMUYNCK D.V.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2010
Last Update Date: 02/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 N GLENORA RD
DUNDEE NY
14837-8817
US

IV. Provider business mailing address

156 N GLENORA RD
DUNDEE NY
14837-8817
US

V. Phone/Fax

Practice location:
  • Phone: 607-738-2092
  • Fax:
Mailing address:
  • Phone: 607-738-2092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number006726-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: