Provider Demographics
NPI:1568500601
Name:GLEASON, GERARD JOHN (LPN)
Entity Type:Individual
Prefix:MR
First Name:GERARD
Middle Name:JOHN
Last Name:GLEASON
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2728 LARKSPUR ST
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HGTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-3027
Mailing Address - Country:US
Mailing Address - Phone:914-962-6404
Mailing Address - Fax:
Practice Address - Street 1:2728 LARKSPUR ST
Practice Address - Street 2:
Practice Address - City:YORKTOWN HGTS
Practice Address - State:NY
Practice Address - Zip Code:10598-3027
Practice Address - Country:US
Practice Address - Phone:914-962-6404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1290451164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01812160Medicaid