Provider Demographics
NPI:1568461713
Name:GAESSER, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:GAESSER
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 1:243 NORTH RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1172
Mailing Address - Country:US
Mailing Address - Phone:845-471-9410
Mailing Address - Fax:845-451-7757
Practice Address - Street 1:1 WEBSTER AVE STE 301
Practice Address - Street 2:SUITE 301, 3RD FLOOR
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1364
Practice Address - Country:US
Practice Address - Phone:845-790-6100
Practice Address - Fax:845-345-9966
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2015-04-23
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
NY219612207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY08S011OtherMEDICARE PTAN
NY02104281Medicaid
NY363284OtherMVP
NY446676OtherAETNA
NY363284OtherMVP