Provider Demographics
NPI:1598842098
Name:GATHERS, SEKULEO (MD)
Entity Type:Individual
Prefix:DR
First Name:SEKULEO
Middle Name:
Last Name:GATHERS
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 1:350 5TH AVE
Mailing Address - Street 2:59TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10118-0110
Mailing Address - Country:US
Mailing Address - Phone:888-970-3777
Mailing Address - Fax:888-970-3777
Practice Address - Street 1:350 5TH AVE 59TH FLOOR
Practice Address - Street 2:NEW YORK PHYSICIAN PLLC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10118
Practice Address - Country:US
Practice Address - Phone:888-970-3777
Practice Address - Fax:888-970-3777
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09595200207P00000X, 207Q00000X
NY235711207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NY00330231Medicare ID - Type Unspecified