Provider Demographics
NPI:1710192208
Name:PATENAUDE, GILBERT EVAN (DC)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:EVAN
Last Name:PATENAUDE
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 1:5673 CASCADE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:NY
Mailing Address - Zip Code:12946-4138
Mailing Address - Country:US
Mailing Address - Phone:518-523-2553
Mailing Address - Fax:518-523-2448
Practice Address - Street 1:5673 CASCADE RD
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:NY
Practice Address - Zip Code:12946-4138
Practice Address - Country:US
Practice Address - Phone:518-523-2553
Practice Address - Fax:518-523-2448
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008710-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYGPOXOF6210OtherBCBS
NYCC0544Medicare UPIN
NYU08285Medicare ID - Type Unspecified