Healthcare Provider Details

I. General information

NPI: 1255670790
Provider Name (Legal Business Name): GARY M GUTIERREZ MSN, NP-C, CCRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 CLOVE RD HOSPITALIST
STATEN ISLAND NY
10301-3627
US

IV. Provider business mailing address

55 WATER ST 12TH FLOOR
NEW YORK NY
10041-0004
US

V. Phone/Fax

Practice location:
  • Phone: 718-816-6440
  • Fax:
Mailing address:
  • Phone: 646-680-2888
  • Fax: 516-542-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00423300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF306162-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: