Provider Demographics
NPI:1205864071
Name:GLEASON, PAUL F (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:F
Last Name:GLEASON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 THEALL RD
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-1404
Mailing Address - Country:US
Mailing Address - Phone:914-848-8800
Mailing Address - Fax:914-848-8801
Practice Address - Street 1:1 THEALL RD
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-1404
Practice Address - Country:US
Practice Address - Phone:914-848-8800
Practice Address - Fax:914-848-8801
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206321207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01986167Medicaid
NY206321OtherLICENSE
NJ25MA09055500OtherSTATE MEDICAL LICENSE
NY2DD7FEE741Medicare PIN