Provider Demographics
NPI:1417311523
Name:GILFUS, NICHOLAS SCOT (FNP)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:SCOT
Last Name:GILFUS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELBRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:13060
Mailing Address - Country:US
Mailing Address - Phone:315-689-0001
Mailing Address - Fax:315-277-5311
Practice Address - Street 1:247 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ELBRIDGE
Practice Address - State:NY
Practice Address - Zip Code:13060-8706
Practice Address - Country:US
Practice Address - Phone:315-689-0001
Practice Address - Fax:315-277-5311
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339935363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04458706Medicaid