Provider Demographics
NPI:1477815843
Name:GIL SARES, GIOVANNY FERNANDO (MD)
Entity Type:Individual
Prefix:
First Name:GIOVANNY
Middle Name:FERNANDO
Last Name:GIL SARES
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 1:4626 67TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-5959
Mailing Address - Country:US
Mailing Address - Phone:718-593-3883
Mailing Address - Fax:
Practice Address - Street 1:87 S OCEAN AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3702
Practice Address - Country:US
Practice Address - Phone:631-569-5335
Practice Address - Fax:631-569-5334
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2016-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME113127207Q00000X
NY284448207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006377600Medicaid
FLGJ281ZMedicare PIN