Provider Demographics
NPI:1609110220
Name:G&E THERAPIES: PHYSICAL, OCCUPATIONAL, SPEECH THERAPY AND PSYCHOLOGICA
Entity Type:Organization
Organization Name:G&E THERAPIES: PHYSICAL, OCCUPATIONAL, SPEECH THERAPY AND PSYCHOLOGICA
Other - Org Name:G&E THERAPIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERILYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-426-3307
Mailing Address - Street 1:236 BURTS ROAD
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:13795-1440
Mailing Address - Country:US
Mailing Address - Phone:877-426-3307
Mailing Address - Fax:877-426-3307
Practice Address - Street 1:236 BURTS ROAD
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:NY
Practice Address - Zip Code:13795-1440
Practice Address - Country:US
Practice Address - Phone:877-426-3307
Practice Address - Fax:877-426-3307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========Medicaid