Provider Demographics
NPI:1760590228
Name:GULMATICO MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:GULMATICO MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANTINO
Authorized Official - Middle Name:V
Authorized Official - Last Name:GULMATICO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:718-258-4848
Mailing Address - Street 1:1430 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-5317
Mailing Address - Country:US
Mailing Address - Phone:718-258-4848
Mailing Address - Fax:718-258-4851
Practice Address - Street 1:1430 E 29TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-5317
Practice Address - Country:US
Practice Address - Phone:718-258-4848
Practice Address - Fax:718-258-4851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02311008Medicaid
NYGU0WEE4810Medicare ID - Type Unspecified