MEDICARE: PHILIP N. GILLEMOT PA

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	009351-1	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CC8362	OTHER	NY	RR MEDICARE GROUP
3	P00027394	OTHER	NY	RR MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912966490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP N. GILLEMOT PA

Provider Business Mailing Address
First Line	:	1 GUTHRIE SQ
Second Line	:
City	:	SAYRE
State	:	PA
Zip	:	18840-1625
Country	:	US
Telephone Number	:	570-888-5858
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 1ST ST
Second Line	:
City	:	WATKINS GLEN
State	:	NY
Zip	:	14891-1260
Country	:	US
Telephone Number	:	607-535-2403
Fax Number	:	607-535-2537

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

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	03/22/2021

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Directions to “ PHILIP N. GILLEMOT PA” Practice Location

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