Provider Demographics
NPI:1003441973
Name:GEORGE, GARY II
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:GEORGE
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E 70TH ST APT 9K2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5354
Mailing Address - Country:US
Mailing Address - Phone:313-212-5193
Mailing Address - Fax:
Practice Address - Street 1:420 E 70TH ST APT 9K2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5354
Practice Address - Country:US
Practice Address - Phone:313-212-5193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program