Provider Demographics
NPI:1457672487
Name:GARY A GONYA MD PLLC
Entity Type:Organization
Organization Name:GARY A GONYA MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GONYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-633-5918
Mailing Address - Street 1:2308 30TH AVE
Mailing Address - Street 2:#6
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-3494
Mailing Address - Country:US
Mailing Address - Phone:917-633-5918
Mailing Address - Fax:646-502-5504
Practice Address - Street 1:2308 30TH AVE
Practice Address - Street 2:#6
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-3494
Practice Address - Country:US
Practice Address - Phone:917-633-5918
Practice Address - Fax:646-502-5504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207XS0117X
NY237278207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty