Healthcare Provider Details

I. General information

NPI: 1417958471
Provider Name (Legal Business Name): DAVID WAYNE GATELY PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 MIDDLEVILLE RD VA MEDICAL CENTER, PSYCHOLOGY SERVICE (116B)
NORTHPORT NY
11768-2200
US

IV. Provider business mailing address

79 MIDDLEVILLE RD VA MEDICAL CENTER, PSYCHOLOGY SERVICE (116B)
NORTHPORT NY
11768-2200
US

V. Phone/Fax

Practice location:
  • Phone: 631-261-4400
  • Fax:
Mailing address:
  • Phone: 631-261-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number011314
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: