Healthcare Provider Details

I. General information

NPI: 1619029402
Provider Name (Legal Business Name): THOMAS E. GIFT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 CHEESE FACTORY RD
HONEOYE FALLS NY
14472-9736
US

IV. Provider business mailing address

670 CHEESE FACTORY RD
HONEOYE FALLS NY
14472-9736
US

V. Phone/Fax

Practice location:
  • Phone: 585-624-3748
  • Fax:
Mailing address:
  • Phone: 585-624-3748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number120846
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number120846
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number120846
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: