Provider Demographics
NPI:1093778383
Name:GINGRAS, GERARD M (ATC)
Entity Type:Individual
Prefix:MR
First Name:GERARD
Middle Name:M
Last Name:GINGRAS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 UPPER COLLEGE DR
Mailing Address - Street 2:ALFRED STATE COLLEGE
Mailing Address - City:ALFRED
Mailing Address - State:NY
Mailing Address - Zip Code:14802-1153
Mailing Address - Country:US
Mailing Address - Phone:607-587-4388
Mailing Address - Fax:
Practice Address - Street 1:10 UPPER COLLEGE DR
Practice Address - Street 2:ALFRED STATE COLLEGE
Practice Address - City:ALFRED
Practice Address - State:NY
Practice Address - Zip Code:14802-1153
Practice Address - Country:US
Practice Address - Phone:607-587-4388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001155-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer