Provider Demographics
NPI:1629040712
Name:BRANCATO, GARETH E (DC)
Entity Type:Individual
Prefix:
First Name:GARETH
Middle Name:E
Last Name:BRANCATO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 NASSAU BLVD S
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5313
Mailing Address - Country:US
Mailing Address - Phone:516-538-3220
Mailing Address - Fax:516-538-3222
Practice Address - Street 1:271 NASSAU BLVD S
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5313
Practice Address - Country:US
Practice Address - Phone:516-538-3220
Practice Address - Fax:516-538-3222
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX003663-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX23641Medicare ID - Type UnspecifiedPROVIDER NUMBER