Healthcare Provider Details

I. General information

NPI: 1790438489
Provider Name (Legal Business Name): GARY CIUFFETELLI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2022
Last Update Date: 02/02/2022
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 NORTH ST
PINE BUSH NY
12566-5917
US

IV. Provider business mailing address

31 NORTH ST
PINE BUSH NY
12566-5917
US

V. Phone/Fax

Practice location:
  • Phone: 845-524-4212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number605672
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: