Provider Demographics
NPI:1275678955
Name:GATTEREAU & EDWARDS MD PC
Entity Type:Organization
Organization Name:GATTEREAU & EDWARDS MD PC
Other - Org Name:ACUMED AMBULATORY LASER & SURGERY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:GATTEREAU EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-468-8400
Mailing Address - Street 1:19105 HILLSIDE AVENUE
Mailing Address - Street 2:
Mailing Address - City:HOLLISWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11423
Mailing Address - Country:US
Mailing Address - Phone:718-468-8400
Mailing Address - Fax:718-740-2211
Practice Address - Street 1:19105 HILLSIDE AVENUE
Practice Address - Street 2:
Practice Address - City:HOLLISWOOD
Practice Address - State:NY
Practice Address - Zip Code:11423
Practice Address - Country:US
Practice Address - Phone:718-468-8400
Practice Address - Fax:718-740-2211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY165011207V00000X
NY161995208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty