Provider Demographics
NPI:1568555480
Name:STUART W. GILLIM MDPC
Entity Type:Organization
Organization Name:STUART W. GILLIM MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GILLIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-835-6570
Mailing Address - Street 1:1969 TIMMERMAN HILL RD.
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045
Mailing Address - Country:US
Mailing Address - Phone:607-835-6570
Mailing Address - Fax:
Practice Address - Street 1:1969 TIMMERMAN HILL RD.
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045
Practice Address - Country:US
Practice Address - Phone:607-835-6570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108764207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
53222AMedicare ID - Type Unspecified
B81284Medicare UPIN