Provider Demographics
NPI:1003818584
Name:VARLOTTA, GERARD P (DO)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:P
Last Name:VARLOTTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 SHAWNEE RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-2211
Mailing Address - Country:US
Mailing Address - Phone:212-725-1800
Mailing Address - Fax:
Practice Address - Street 1:20 E 46TH ST RM 304
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-9286
Practice Address - Country:US
Practice Address - Phone:212-725-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1593462083S0010X, 2084P2900X, 2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY159346-6BOtherNYS WORKERS COMPENSATION
NYBV2705462OtherDEA
NY159346-6BOtherNYS WORKERS COMPENSATION
NYE95026Medicare UPIN
NY15G532Medicare PIN