MEDICARE: JOY GAVIGAN NP

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	403114	NY

General Provider Information

NPI Number	:	1982219903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOY GAVIGAN NP

Provider Business Mailing Address
First Line	:	254 S MAIN ST STE 519
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-3388
Country	:	US
Telephone Number	:	845-327-9515
Fax Number	:	845-245-6562

Provider Business Practice Location Address
First Line	:	254 S MAIN ST STE 519
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-3388
Country	:	US
Telephone Number	:	914-327-9515
Fax Number	:	914-327-9515

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

Provider Enumeration Date	:	09/15/2020
Last Update Date	:	03/12/2026

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