Healthcare Provider Details

I. General information

NPI: 1124089008
Provider Name (Legal Business Name): DAVID P GATTA ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1157 ROUTE 55 ARLINGTON HIGH SCHOOL
LAGRANGEVILLE NY
12540-5021
US

IV. Provider business mailing address

35 PARKWOOD BLVD POUGHKEEPSIE
POUGHKEEPSIE NY
12603-4113
US

V. Phone/Fax

Practice location:
  • Phone: 845-486-4860
  • Fax: 845-483-3999
Mailing address:
  • Phone: 845-485-4850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number215
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: