Healthcare Provider Details

I. General information

NPI: 1275194813
Provider Name (Legal Business Name): DR. GAURAV SINGH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FAMILY PRACTICE DR
KINGSTON NY
12401-6449
US

IV. Provider business mailing address

1425 PORTLAND AVE
ROCHESTER NY
14621
US

V. Phone/Fax

Practice location:
  • Phone: 845-338-6400
  • Fax:
Mailing address:
  • Phone: 585-922-4731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number007268
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number007268
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number007268
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: