Healthcare Provider Details

I. General information

NPI: 1699939249
Provider Name (Legal Business Name): DAVID GUDIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 03/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 FORT WASHINGTON AVE FL 7
NEW YORK NY
10032-3722
US

IV. Provider business mailing address

180 FORT WASHINGTON AVE FL 8
NEW YORK NY
10032-3722
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-8555
  • Fax: 212-305-3975
Mailing address:
  • Phone: 212-305-8555
  • Fax: 212-305-3975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number35832
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT193549
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number278963
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: