Provider Demographics
NPI:1588645238
Name:GUILFOYLE, GARY OWEN (AUD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:OWEN
Last Name:GUILFOYLE
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-1819
Mailing Address - Country:US
Mailing Address - Phone:518-885-0025
Mailing Address - Fax:
Practice Address - Street 1:18 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-1819
Practice Address - Country:US
Practice Address - Phone:518-885-0025
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1249-1237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY040426005829OtherFIDELIS
NY10000820OtherCDPHP
NY922068OtherMVP
NY4800227OtherGHI
NY000412015001OtherBLUE SHIELD NENY
NYM03821OtherEMPIRE BC BS
NY922068OtherMVP