Provider Demographics
NPI:1770644601
Name:AYALA, GLADYS MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:GLADYS
Middle Name:MARIA
Last Name:AYALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-5213
Mailing Address - Country:US
Mailing Address - Phone:718-919-4072
Mailing Address - Fax:
Practice Address - Street 1:40 SUNSHINE COTTAGE RD
Practice Address - Street 2:NEW YORK MEDICAL COLLEGE ADMIN BLDING STUDENT AFFAIRS
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1524
Practice Address - Country:US
Practice Address - Phone:914-594-4498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173694207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01132223Medicaid
NYGA017F0410Medicare ID - Type Unspecified
NYD92214Medicare UPIN