=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902839004
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOX MEDICAL ANESTHESIA ASSOCIATES, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2006
-----------------------------------------------------
Last Update Date | 08/15/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 NORTON AVE
-----------------------------------------------------
City | ONEONTA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13820-2629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-432-4024
-----------------------------------------------------
Fax | 607-432-4773
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 249
-----------------------------------------------------
City | ONEONTA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13820-0249
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-432-4024
-----------------------------------------------------
Fax | 607-432-4773
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. TERENCE J. GILBERT
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 607-432-4024
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------