Provider Demographics
NPI: | 1376585067 |
---|---|
Name: | SINENSKY, GARY B (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | GARY |
Middle Name: | B |
Last Name: | SINENSKY |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 425 GUY PARK AVE STE 201 |
Mailing Address - Street 2: | |
Mailing Address - City: | AMSTERDAM |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 12010-1059 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 518-843-1240 |
Mailing Address - Fax: | 518-842-2935 |
Practice Address - Street 1: | 427 GUY PARK AVE STE 201 |
Practice Address - Street 2: | |
Practice Address - City: | AMSTERDAM |
Practice Address - State: | NY |
Practice Address - Zip Code: | 12010 |
Practice Address - Country: | US |
Practice Address - Phone: | 518-843-1240 |
Practice Address - Fax: | 518-842-2935 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-06-10 |
Last Update Date: | 2024-02-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WI | 81818 | 207RG0100X |
KY | TP824 | 207RG0100X |
MI | 4301510330 | 207RG0100X |
NY | 139083 | 207RG0100X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | 04055643 | Medicaid | |
223429607 | Other | EIN | |
440618 | Medicare ID - Type Unspecified | ||
NJ | 0292508 | Medicaid |