Provider Demographics
NPI:1023014776
Name:GAGE, DENNIS (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
Last Name:GAGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 EAST 75TH ST
Mailing Address - Street 2:APT 1FE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2805
Mailing Address - Country:US
Mailing Address - Phone:212-772-7628
Mailing Address - Fax:212-772-7062
Practice Address - Street 1:103 E 75TH ST
Practice Address - Street 2:APT 1FE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2805
Practice Address - Country:US
Practice Address - Phone:212-772-7628
Practice Address - Fax:212-772-7062
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131072207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00580209Medicaid
NY00580209Medicaid
NY45A951Medicare PIN