MEDICARE: DR. SEKULEO GATHERS MD

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	207P00000X	Emergency Medicine Physician	25MA09595200	NJ
2	207P00000X	Emergency Medicine Physician	235711	NY
3	207Q00000X	Family Medicine Physician	235711	NY
4	207Q00000X	Family Medicine Physician	25MA09595200	NJ

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

General Provider Information

NPI Number	:	1598842098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEKULEO GATHERS MD

Provider Business Mailing Address
First Line	:	350 5TH AVE
Second Line	:	59TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10118-0110
Country	:	US
Telephone Number	:	888-970-3777
Fax Number	:	888-970-3777

Provider Business Practice Location Address
First Line	:	350 5TH AVE 59TH FLOOR
Second Line	:	NEW YORK PHYSICIAN PLLC
City	:	NEW YORK
State	:	NY
Zip	:	10118
Country	:	US
Telephone Number	:	888-970-3777
Fax Number	:	888-970-3777

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	04/23/2025

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