=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609905819
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | G&P GYNECARE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 306 CENTRAL AVE
-----------------------------------------------------
City | DUNKIRK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14048-2125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-366-4210
-----------------------------------------------------
Fax | 716-366-3549
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 306 CENTRAL AVE
-----------------------------------------------------
City | DUNKIRK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14048-2125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-366-4210
-----------------------------------------------------
Fax | 716-366-3549
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MS. GERRY M VACANTI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 716-366-4210
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 151520
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------