Provider Demographics
NPI:1093810756
Name:GARBUS, GARY L (DPM)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:L
Last Name:GARBUS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-4913
Mailing Address - Country:US
Mailing Address - Phone:845-356-1534
Mailing Address - Fax:845-356-3970
Practice Address - Street 1:20 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-4913
Practice Address - Country:US
Practice Address - Phone:845-356-1534
Practice Address - Fax:845-356-3970
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN3735213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01062573Medicaid
NYT51235Medicare UPIN
NY1499740001Medicare NSC
NYP40251Medicare PIN