Provider Demographics
NPI:1164482113
Name:MCCAFFERTY, GAYE (NP)
Entity Type:Individual
Prefix:
First Name:GAYE
Middle Name:
Last Name:MCCAFFERTY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GAYE
Other - Middle Name:
Other - Last Name:BOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:314 S MANNING BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-1708
Mailing Address - Country:US
Mailing Address - Phone:518-437-5963
Mailing Address - Fax:518-437-5965
Practice Address - Street 1:314 S MANNING BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1708
Practice Address - Country:US
Practice Address - Phone:518-437-5963
Practice Address - Fax:518-437-5965
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3032832084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02197799Medicaid
NYCC7337Medicare ID - Type Unspecified
J400124646Medicare PIN
NY02197799Medicaid