=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760423131
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY MEDICINE P C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 825 ROUTE 211 E
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10941-1443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-692-8338
-----------------------------------------------------
Fax | 845-692-6177
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 825 ROUTE 211 E
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10941-1443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. GAETAN ZAMILUS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 845-692-8338
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 212737
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------