MEDICARE: GERALD E. TURK NPP-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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	400765	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000560995002	OTHER	NY	COMMUNITY BLUE

General Provider Information

NPI Number	:	1548203516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALD E. TURK NPP-C

Provider Business Mailing Address
First Line	:	9077 STATE ROUTE 408
Second Line	:
City	:	NUNDA
State	:	NY
Zip	:	14517-9728
Country	:	US
Telephone Number	:	585-468-2173
Fax Number	:	585-468-2172

Provider Business Practice Location Address
First Line	:	9077 STATE ROUTE 408
Second Line	:
City	:	NUNDA
State	:	NY
Zip	:	14517-9728
Country	:	US
Telephone Number	:	585-468-2173
Fax Number	:	585-468-2172

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	04/04/2012

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