Healthcare Provider Details

I. General information

NPI: 1952355216
Provider Name (Legal Business Name): GAYLE MOSHER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N MAIN ST
WAYLAND NY
14572-1034
US

IV. Provider business mailing address

PO BOX 601
DANSVILLE NY
14437-0601
US

V. Phone/Fax

Practice location:
  • Phone: 585-728-5131
  • Fax:
Mailing address:
  • Phone: 585-335-3416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number190050-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01349962
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: