Provider Demographics
NPI:1437232956
Name:DAGNESE, GERARD (MD)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:
Last Name:DAGNESE
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 1:2050 SAW MILL RIVER RD
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-4143
Mailing Address - Country:US
Mailing Address - Phone:914-245-4330
Mailing Address - Fax:
Practice Address - Street 1:2050 SAW MILL RIVER RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:YORKTOWN HTS
Practice Address - State:NY
Practice Address - Zip Code:10598
Practice Address - Country:US
Practice Address - Phone:914-245-4330
Practice Address - Fax:914-245-0345
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170481207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01735753Medicaid
D92143Medicare UPIN
NY01F461Medicare PIN