Healthcare Provider Details

I. General information

NPI: 1063692796
Provider Name (Legal Business Name): GERALD EINAUGLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 NEWPORT DRIVE
HEWLETT NY
11557-1013
US

IV. Provider business mailing address

33 NEWPORT DRIVE
HEWLETT NY
11557-1013
US

V. Phone/Fax

Practice location:
  • Phone: 516-532-3720
  • Fax: 516-791-6416
Mailing address:
  • Phone: 516-532-3720
  • Fax: 516-791-6416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number129970
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: