Provider Demographics
NPI:1114335171
Name:GASKINS, OLGA
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:GASKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-1791
Mailing Address - Country:US
Mailing Address - Phone:845-896-7730
Mailing Address - Fax:845-896-0273
Practice Address - Street 1:969 MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524
Practice Address - Country:US
Practice Address - Phone:845-896-7730
Practice Address - Fax:845-896-7758
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056899363A00000X
NY022024-1207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05427436Medicaid