MEDICARE: JOEL C GISH RPA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	010328	NY
2	363A00000X	Physician Assistant	MA051817	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	284057	OTHER	NY	HMO - ULSTER PARK
3	284221	OTHER	NY	HMO - ELKA PARK

General Provider Information

NPI Number	:	1306813688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL C GISH RPA-C

Provider Business Mailing Address
First Line	:	10 HELLBROOK LN
Second Line	:
City	:	ULSTER PARK
State	:	NY
Zip	:	12487-5209
Country	:	US
Telephone Number	:	845-658-7763
Fax Number	:

Provider Business Practice Location Address
First Line	:	359 GIBSON HILL RD
Second Line	:
City	:	CHESTER
State	:	NY
Zip	:	10918
Country	:	US
Telephone Number	:	845-572-3412
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2006
Last Update Date	:	03/07/2023

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Directions to “ JOEL C GISH RPA-C” Practice Location

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