Provider Demographics
NPI:1205007549
Name:GINGRICH ONCOLOGY PLLC
Entity Type:Organization
Organization Name:GINGRICH ONCOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GINGRICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-462-6161
Mailing Address - Street 1:PO BOX 62265
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-2265
Mailing Address - Country:US
Mailing Address - Phone:570-451-3910
Mailing Address - Fax:570-451-3295
Practice Address - Street 1:1 WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1361
Practice Address - Country:US
Practice Address - Phone:845-483-5747
Practice Address - Fax:845-483-5797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1299001207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW26261Medicare PIN