Healthcare Provider Details

I. General information

NPI: 1770978280
Provider Name (Legal Business Name): GARY CIUFFETELLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2834 ROUTE 17M
NEW HAMPTON NY
10958-5011
US

IV. Provider business mailing address

2834 ROUTE 17M
NEW HAMPTON NY
10958-5011
US

V. Phone/Fax

Practice location:
  • Phone: 845-374-8700
  • Fax:
Mailing address:
  • Phone: 845-374-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number310694
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: