Provider Demographics
NPI:1083871669
Name:GUBLO, G MICHAEL (CPO)
Entity Type:Individual
Prefix:MR
First Name:G MICHAEL
Middle Name:
Last Name:GUBLO
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 MORNING GLORY LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4729
Mailing Address - Country:US
Mailing Address - Phone:585-663-5860
Mailing Address - Fax:585-368-9274
Practice Address - Street 1:1401 STONE RD
Practice Address - Street 2:SUITE 201B
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615-1537
Practice Address - Country:US
Practice Address - Phone:585-663-5860
Practice Address - Fax:585-368-9274
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6142190001Medicare NSC